Provider Demographics
NPI:1992882211
Name:VASCULAR SURGICAL ASSOC
Entity type:Organization
Organization Name:VASCULAR SURGICAL ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAJAKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-876-7400
Mailing Address - Street 1:1225 PARK AVE
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128
Mailing Address - Country:US
Mailing Address - Phone:212-876-7400
Mailing Address - Fax:212-831-8090
Practice Address - Street 1:1225 PARK AVE
Practice Address - Street 2:SUITE 1D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128
Practice Address - Country:US
Practice Address - Phone:212-876-7400
Practice Address - Fax:212-831-8090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7099982086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02491394Medicaid
NY02491394Medicaid
H99525Medicare UPIN