Healthcare Provider Details

I. General information

NPI: 1356348536
Provider Name (Legal Business Name): CARLO BAYRAKDARIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2005
Last Update Date: 10/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 GREENRIDGE AVE
WHITE PLAINS NY
10605-1618
US

IV. Provider business mailing address

50 OGDEN RD
SCARSDALE NY
10583-3021
US

V. Phone/Fax

Practice location:
  • Phone: 914-948-3904
  • Fax:
Mailing address:
  • Phone: 914-948-3904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number214022
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: