Provider Demographics
NPI:1316054539
Name:BOYADJIAN, KEVORK GEORGE (MD)
Entity type:Individual
Prefix:DR
First Name:KEVORK
Middle Name:GEORGE
Last Name:BOYADJIAN
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 1:7506 ELIOT AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-1207
Mailing Address - Country:US
Mailing Address - Phone:718-639-4258
Mailing Address - Fax:
Practice Address - Street 1:7506 ELIOT AVE
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-1207
Practice Address - Country:US
Practice Address - Phone:718-639-4258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY180550207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY67993AMedicare PIN
E50297Medicare UPIN