Provider Demographics
NPI:1174587760
Name:PAMOUKIAN, VICKEN N (MD)
Entity type:Individual
Prefix:
First Name:VICKEN
Middle Name:N
Last Name:PAMOUKIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 VINCENT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-1720
Mailing Address - Country:US
Mailing Address - Phone:212-433-4421
Mailing Address - Fax:718-744-2742
Practice Address - Street 1:166 E 88TH ST FL 1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-2255
Practice Address - Country:US
Practice Address - Phone:212-433-4421
Practice Address - Fax:718-744-2742
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2161082086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02443281Medicaid
NY216108OtherLICENSE
DCBP8134556OtherDEA CERTIFICATE #
NY02443281Medicaid