Provider Demographics
NPI:1942253158
Name:BAGHDASSARIAN, BAGDIG S (MD)
Entity Type:Individual
Prefix:
First Name:BAGDIG
Middle Name:S
Last Name:BAGHDASSARIAN
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 1:15 ARLEIGH RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1324
Mailing Address - Country:US
Mailing Address - Phone:516-383-9077
Mailing Address - Fax:516-466-2980
Practice Address - Street 1:15 ARLEIGH RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-1324
Practice Address - Country:US
Practice Address - Phone:516-566-1139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175909207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01297401Medicaid
NY43F692Medicare PIN
NY01297401Medicaid