Provider Demographics
NPI:1134172018
Name:KEUKJIAN, VAHE (MD)
Entity type:Individual
Prefix:
First Name:VAHE
Middle Name:
Last Name:KEUKJIAN
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:PO BOX 2000
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-2000
Mailing Address - Country:US
Mailing Address - Phone:518-828-8363
Mailing Address - Fax:518-697-3388
Practice Address - Street 1:71 PROSPECT AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-2907
Practice Address - Country:US
Practice Address - Phone:518-828-3327
Practice Address - Fax:518-697-8158
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-190528207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
141483OtherWELLCARE
NY01374556Medicaid
16L472OtherBC/BS
10031632OtherCDPHP
9600083OtherGHI PPO
1924404OtherUNITED HEALTH CARE
000492005001OtherBSNENY
26734OtherGHI HMO
040426007279OtherFIDELIS
080139873OtherRAILROAD MEDICARE
087225OtherMVP
NYF45402Medicare UPIN
000492005001OtherBSNENY
087225OtherMVP