Healthcare Provider Details

I. General information

NPI: 1699713727
Provider Name (Legal Business Name): OHANIAN, HERIPSIME, PHD, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
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:
Mailing address:
  • Phone: 201-265-9042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. HERIPSIME OHANIAN
Title or Position: OWNER
Credential: MD
Phone: 201-265-9042