Healthcare Provider Details

I. General information

NPI: 1669653085
Provider Name (Legal Business Name): OHANES K CHOLAKIAN PHYSICIAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108-48 70TH ROAD
FOREST HILLS NY
11375
US

IV. Provider business mailing address

108-48 70TH ROAD
FOREST HILLS NY
11375
US

V. Phone/Fax

Practice location:
  • Phone: 718-520-1520
  • Fax: 718-520-0888
Mailing address:
  • Phone: 718-520-1520
  • Fax: 718-520-0888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number183615
License Number StateNY

VIII. Authorized Official

Name: OHANES K CHOLAKIAN
Title or Position: OWNER
Credential: MD
Phone: 718-520-1520