Provider Demographics
NPI:1902833536
Name:YEGHIAYAN, PAULA (MD)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:
Last Name:YEGHIAYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 WESTAGE BUSINESS CTR DR
Mailing Address - Street 2:SUITE 280
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-2260
Mailing Address - Country:US
Mailing Address - Phone:800-835-3723
Mailing Address - Fax:
Practice Address - Street 1:155 E 31ST ST APT 23F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6872
Practice Address - Country:US
Practice Address - Phone:212-213-3226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2316222085R0202X, 2085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02671965Medicaid
NY747T31Medicare ID - Type Unspecified
NY02671965Medicaid