Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 246961-1 | NY |
N | 111NI0900X | Internist | 246961-1 | NY |
N | 207R00000X | Internist | 25MB08886200 | NJ |
N | 111NI0900X | Internist | 25MB08886200 | NJ |
Y | 207RC0000X | Internist - Cardiovascular Disease | 25MB08886200 | NJ |
NPI | 1023296936 |
---|---|
Provider Name | Dr. Hrach Ike Kasaryan |
First Address | Teaneck, NJ 07666-6839 |
Second Address | Teaneck, NJ 07666-6839 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2008 |
Last Update Date | 28/01/2016 |