Provider Demographics
NPI:1982640108
Name:HEALY, KIRSTEN ODABASHIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:ODABASHIAN
Last Name:HEALY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 E 78TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0408
Mailing Address - Country:US
Mailing Address - Phone:212-772-9222
Mailing Address - Fax:212-879-7235
Practice Address - Street 1:170 E 78TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0408
Practice Address - Country:US
Practice Address - Phone:212-772-9222
Practice Address - Fax:212-879-7235
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234897207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY234897OtherNYS EDUCATION DEPARTMENT
NY02768867Medicaid
NYJ400019822Medicare PIN