Provider Demographics
NPI:1669522744
Name:AVEDISSIAN, HAROUTIUN CHAVARCH (MD)
Entity type:Individual
Prefix:MR
First Name:HAROUTIUN
Middle Name:CHAVARCH
Last Name:AVEDISSIAN
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 1:500 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:OLMMC, DEPT. OF MEDICINE
Practice Address - Street 2:600 EAST 233 STR.
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466
Practice Address - Country:US
Practice Address - Phone:718-920-9889
Practice Address - Fax:718-920-9036
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210756207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01859576Medicaid
NYG72262Medicare UPIN
NY01859576Medicaid