Basic Information
| Provider Information | |||||||||
| NPI: | 1396895785 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARJARIAN | ||||||||
| FirstName: | ASTRA | ||||||||
| MiddleName: | ARDASHES | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 W 43RD ST | ||||||||
| Address2: | APT. 36 E | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100364327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126958278 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4330 48TH ST | ||||||||
| Address2: | SUITE AA2 | ||||||||
| City: | SUNNYSIDE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 111041648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187067658 | ||||||||
| FaxNumber: | 7187061200 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 210064 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01856757 | 05 | NY | MEDICAID |