Provider Demographics
NPI:1922716455
Name:VISA VASCULAR CARE PC
Entity Type:Organization
Organization Name:VISA VASCULAR CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICKEN
Authorized Official - Middle Name:NICHAN
Authorized Official - Last Name:PAMOUKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-433-4421
Mailing Address - Street 1:515 E 79TH ST APT 23B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0780
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:166 E 88TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-2255
Practice Address - Country:US
Practice Address - Phone:212-433-4421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-14
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty