Healthcare Provider Details

I. General information

NPI: 1336260504
Provider Name (Legal Business Name): GEORGE ARDASH ANASTASIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DAVIS AVE AT E POST RD
WHITE PLAINS NY
10601-4615
US

IV. Provider business mailing address

435 E 70TH ST APT. 26J
NEW YORK NY
10021-5342
US

V. Phone/Fax

Practice location:
  • Phone: 914-681-0600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number234420-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: