Provider Demographics
NPI:1285389973
Name:KEUSSEYAN, GARBIS D
Entity type:Individual
Prefix:
First Name:GARBIS
Middle Name:D
Last Name:KEUSSEYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 GREEN ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-2911
Mailing Address - Country:US
Mailing Address - Phone:781-859-9105
Mailing Address - Fax:
Practice Address - Street 1:23 NORTH ST STE 4
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-2295
Practice Address - Country:US
Practice Address - Phone:207-764-3142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-21
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical