Individual
JONATHAN MARDIROSSIAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12 MAPLEMOOR LANE, WHITE PLAINS, NY 10605-4704
(914) 684-0020
Mailing address
12 MAPLEMOOR LANE, WHITE PLAINS, NY 10605-4704
(914) 684-0020
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
01028855A
IN
207W00000X
Ophthalmology Physician
Primary
116323
NY
207W00000X
Ophthalmology Physician
25MA03332300
NJ
207W00000X
Ophthalmology Physician
G031724
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00752694
—
NY
01
—
P00278038
RAILROAD MEDICARE
—
05
—
P3007526949
—
NY
Enumeration date
01/04/2006
Last updated
04/12/2013
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