Provider Demographics
NPI:1891009718
Name:OUR TOWN MEDICAL PC
Entity type:Organization
Organization Name:OUR TOWN MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARMAND
Authorized Official - Middle Name:VARUJAN
Authorized Official - Last Name:ASADOURIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-476-2900
Mailing Address - Street 1:6946 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-1827
Mailing Address - Country:US
Mailing Address - Phone:718-476-2900
Mailing Address - Fax:718-478-4355
Practice Address - Street 1:6946 GRAND AVE
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-1827
Practice Address - Country:US
Practice Address - Phone:718-476-2900
Practice Address - Fax:718-478-4355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163565208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty