MEDICARE: VICKEN N PAMOUKIAN MD

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	2086S0129X	Vascular Surgery Physician	216108	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	216108	OTHER	NY	LICENSE

General Provider Information

NPI Number	:	1174587760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKEN N PAMOUKIAN MD

Provider Business Mailing Address
First Line	:	653 VINCENT AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10465-1720
Country	:	US
Telephone Number	:	212-433-4421
Fax Number	:	718-744-2742

Provider Business Practice Location Address
First Line	:	166 E 88TH ST FL 1
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10128-2255
Country	:	US
Telephone Number	:	212-433-4421
Fax Number	:	718-744-2742

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	03/07/2023

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