Healthcare Provider Details

I. General information

NPI: 1609338565
Provider Name (Legal Business Name): YERAZ KHACHATOORIAN MD, MSPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 W 168TH ST # 4
NEW YORK NY
10032-3725
US

IV. Provider business mailing address

630 W 168TH ST # 4
NEW YORK NY
10032-3725
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-4275
  • Fax: 212-305-7237
Mailing address:
  • Phone: 212-305-4275
  • Fax: 212-305-7237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number326661
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: