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General NPI Number Information
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NPI Number | 1396400925
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Entity Type | Individual
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Provider Name | NAREK GAGIK BAZYAN PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/08/2021
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 156 WILLIAM ST RM 303
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City | NEW YORK
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State | NY
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Zip | 10038-5307
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Country | US
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Telephone | 888-803-3370
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Fax |
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Provider Business Mailing Address
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Address Line | 3610 31ST ST UNIT 4C
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City | ASTORIA
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State | NY
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Zip | 11106-2323
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Country | US
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Telephone | 347-284-8802
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 027853
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License Number State | NY
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