Provider Demographics
NPI:1811489891
Name:ARUSTAMYAN, MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:ARUSTAMYAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 NICOLLS ROAD
Mailing Address - Street 2:HEALTH SCIENCES CENTER, LEVEL 4
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8434
Mailing Address - Country:US
Mailing Address - Phone:631-216-9094
Mailing Address - Fax:631-615-4681
Practice Address - Street 1:101 NICOLLS ROAD
Practice Address - Street 2:HEALTH SCIENCES CENTER, LEVEL 4
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8434
Practice Address - Country:US
Practice Address - Phone:631-216-9094
Practice Address - Fax:631-615-4681
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT018282207R00000X
IADO-05778207RC0000X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease