Provider Demographics
NPI:1396895785
Name:GARJARIAN, ASTRA ARDASHES (MD)
Entity type:Individual
Prefix:MRS
First Name:ASTRA
Middle Name:ARDASHES
Last Name:GARJARIAN
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 1:500 W 43RD ST
Mailing Address - Street 2:APT. 36 E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-4327
Mailing Address - Country:US
Mailing Address - Phone:212-695-8278
Mailing Address - Fax:
Practice Address - Street 1:4330 48TH ST
Practice Address - Street 2:SUITE AA2
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-1648
Practice Address - Country:US
Practice Address - Phone:718-706-7658
Practice Address - Fax:718-706-1200
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210064207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01856757Medicaid
NY04203Medicare ID - Type UnspecifiedGHI MEDICARE
NY795941Medicare ID - Type UnspecifiedEMPIRE MEDICARE
NY795942Medicare ID - Type UnspecifiedEMPIRE MEDICARE
NY01856757Medicaid
NYAG004203AMedicare ID - Type UnspecifiedMEDICARE