MEDICARE: YOUR FAMILY DOC, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1053672238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUR FAMILY DOC, P.C.

Provider Business Mailing Address
First Line	:	2 SHERMAN POTTS DR
Second Line	:
City	:	GHENT
State	:	NY
Zip	:	12075-3216
Country	:	US
Telephone Number	:	518-314-0889
Fax Number	:	518-244-8812

Provider Business Practice Location Address
First Line	:	2 SHERMAN POTTS DR
Second Line	:
City	:	GHENT
State	:	NY
Zip	:	12075-3216
Country	:	US
Telephone Number	:	518-314-0889
Fax Number	:	518-244-8812

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VAHE AVEDIS KEUKJIAN
Credential	:	MD
Telephone Number	:	518-314-0889

Provider Enumeration Date	:	06/04/2012
Last Update Date	:	07/11/2012

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Directions to “YOUR FAMILY DOC, P.C. ” Practice Location

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