Basic Information
Provider Information
NPI: 1558336495
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ARMAND
FirstName: CAMILLE
MiddleName: GERARD
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1981 MARCUS AVE
Address2: SUITE 208
City: LAKE SUCCESS
State: NY
PostalCode: 110421038
CountryCode: US
TelephoneNumber: 7186618711
FaxNumber:  
Practice Location
Address1: 2525 KINGS HWY
Address2:  
City: BROOKLYN
State: NY
PostalCode: 112291705
CountryCode: US
TelephoneNumber: 7186925300
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/22/2006
LastUpdateDate: 10/27/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000X165678NYY Allopathic & Osteopathic PhysiciansSurgery 

ID Information
IDTypeStateIssuerDescription
0105143605NY MEDICAID


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