Provider Demographics
NPI:1134151731
Name:CANAVARROS, ARARY B (MD)
Entity type:Individual
Prefix:DR
First Name:ARARY
Middle Name:B
Last Name:CANAVARROS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:400 HORSEBLOCK RD STE H
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-1252
Mailing Address - Country:US
Mailing Address - Phone:631-451-2211
Mailing Address - Fax:
Practice Address - Street 1:400 HORSEBLOCK RD STE H
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-1252
Practice Address - Country:US
Practice Address - Phone:631-451-2211
Practice Address - Fax:631-451-1463
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY222080207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY016AS1Medicare ID - Type Unspecified
NYH00189Medicare UPIN