Provider Demographics
NPI:1215966593
Name:KAZANJIAN, HRATCH (MD)
Entity type:Individual
Prefix:DR
First Name:HRATCH
Middle Name:
Last Name:KAZANJIAN
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 1:20 GRAND STREET
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1035
Mailing Address - Country:US
Mailing Address - Phone:845-987-3901
Mailing Address - Fax:845-987-5979
Practice Address - Street 1:30 HATFIELD LN
Practice Address - Street 2:SUITE 209
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-6766
Practice Address - Country:US
Practice Address - Phone:845-294-7510
Practice Address - Fax:845-294-7982
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191777-1207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01573073Medicaid
NJ5291305Medicaid
NJ415325MBQMedicare ID - Type Unspecified
NJ5291305Medicaid
NY01573073Medicaid