Healthcare Provider Details

I. General information

NPI: 1760880330
Provider Name (Legal Business Name): DOUGLAS KECHIJIAN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2014
Last Update Date: 12/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 W 21ST ST 8TH FLOOR
NEW YORK NY
10010-6908
US

IV. Provider business mailing address

54 W 21ST ST 8TH FLOOR
NEW YORK NY
10010-6908
US

V. Phone/Fax

Practice location:
  • Phone: 212-229-3670
  • Fax:
Mailing address:
  • Phone: 212-229-3670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number037754
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: