Provider Demographics
NPI:1922194935
Name:KAYMAKCIAN KAYAJIAN, MARI (RPA-C)
Entity Type:Individual
Prefix:
First Name:MARI
Middle Name:
Last Name:KAYMAKCIAN KAYAJIAN
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 GRANDVIEW DR FL 8
Mailing Address - Street 2:
Mailing Address - City:VALATIE
Mailing Address - State:NY
Mailing Address - Zip Code:12184-4706
Mailing Address - Country:US
Mailing Address - Phone:518-588-9692
Mailing Address - Fax:
Practice Address - Street 1:55 PITTSFIELD RD STE 9
Practice Address - Street 2:
Practice Address - City:LENOX
Practice Address - State:MA
Practice Address - Zip Code:01240-2185
Practice Address - Country:US
Practice Address - Phone:413-637-9991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007746363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP26748Medicare UPIN