Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 216108 | NY |
NPI | 1174587760 |
---|---|
Provider Name | Vicken N Pamoukian |
First Address | New York, NY 10075-1851 |
Second Address | New York, NY 10075-1851 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2006 |
Last Update Date | 06/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02443281 | (05) | NY |
216108 | LICENSE (01) | NY |
I01467 | (02) | NY |