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General NPI Number Information
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NPI Number | 1205691821
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Entity Type | Organization
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Legal Business Name | GOTHAM VASCULAR SURGERY PC
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Dates
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Enumeration Date | 02/14/2024
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Last Update Date | 02/14/2024
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Provider Practice Location Address
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Address Line | 166 E 88TH ST
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City | NEW YORK
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State | NY
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Zip | 10128-2255
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Country | US
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Telephone | 212-433-4421
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Fax | 718-744-2742
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Provider Business Mailing Address
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Address Line | 515 E 79TH ST APT 23B
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City | NEW YORK
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State | NY
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Zip | 10075-0780
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Country | US
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Telephone | 212-433-4421
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Fax | 718-744-2742
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VICKEN PAMOUKIAN
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Credential | MD
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Telephone | 212-433-4421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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