Healthcare Provider Details

I. General information

NPI: 1902932395
Provider Name (Legal Business Name): VARSENIK ARVANIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 HALF HOLLOW RD
DIX HILLS NY
11746-5861
US

IV. Provider business mailing address

10 GLADES WAY
HALESITE NY
11743-2133
US

V. Phone/Fax

Practice location:
  • Phone: 631-673-7700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number227583
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: