Provider Demographics
NPI:1619079837
Name:KAMALIAN, MICHEL H (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHEL
Middle Name:H
Last Name:KAMALIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1995 ROUTE 17M
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-5231
Mailing Address - Country:US
Mailing Address - Phone:845-294-8815
Mailing Address - Fax:845-294-3586
Practice Address - Street 1:1995 ROUTE 17M
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-5231
Practice Address - Country:US
Practice Address - Phone:845-294-8815
Practice Address - Fax:845-294-3586
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY107040-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB18530Medicare UPIN
NY684821Medicare ID - Type UnspecifiedMEDICARE
NYW16541Medicare ID - Type UnspecifiedMEDICARE DIAGNOSTIC #