Healthcare Provider Details

I. General information

NPI: 1215966593
Provider Name (Legal Business Name): HRATCH KAZANJIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 08/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HATFIELD LN SUITE 209
GOSHEN NY
10924-6766
US

IV. Provider business mailing address

20 GRAND STREET 3RD FLOOR
WARWICK NY
10990-1035
US

V. Phone/Fax

Practice location:
  • Phone: 845-294-7510
  • Fax: 845-294-7982
Mailing address:
  • Phone: 845-987-3901
  • Fax: 845-987-5979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number191777-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: