Healthcare Provider Details

I. General information

NPI: 1174587760
Provider Name (Legal Business Name): VICKEN N PAMOUKIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 03/07/2023
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 E 88TH ST FL 1
NEW YORK NY
10128-2255
US

IV. Provider business mailing address

653 VINCENT AVE
BRONX NY
10465-1720
US

V. Phone/Fax

Practice location:
  • Phone: 212-433-4421
  • Fax: 718-744-2742
Mailing address:
  • Phone: 212-433-4421
  • Fax: 718-744-2742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number216108
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: