Healthcare Provider Details

I. General information

NPI: 1205691821
Provider Name (Legal Business Name): GOTHAM VASCULAR SURGERY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

515 E 79TH ST APT 23B
NEW YORK NY
10075-0780
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 Number
License Number State

VIII. Authorized Official

Name: DR. VICKEN PAMOUKIAN
Title or Position: PRESIDENT
Credential: MD
Phone: 212-433-4421