Healthcare Provider Details

I. General information

NPI: 1134113582
Provider Name (Legal Business Name): HERIPSIME OHANIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 09/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KALISA WAY SUITE 103
PARAMUS NJ
07652-3516
US

IV. Provider business mailing address

1 KALISA WAY SUITE 103
PARAMUS NJ
07652-3516
US

V. Phone/Fax

Practice location:
  • Phone: 201-265-9042
  • Fax: 201-265-1682
Mailing address:
  • Phone: 201-265-9042
  • Fax: 201-265-1682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA05134100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: