Healthcare Provider Details

I. General information

NPI: 1467549832
Provider Name (Legal Business Name): NELLY JOUAYED OUNDJIAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NELLY JOUAYED M.D.

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 RIPPLEWOOD DR
UPPER SADDLE RIVER NJ
07458-1410
US

IV. Provider business mailing address

506 MALCOLM X BLVD WP-522
NEW YORK NY
10037-1802
US

V. Phone/Fax

Practice location:
  • Phone: 201-825-0464
  • Fax: 201-825-0464
Mailing address:
  • Phone: 212-939-2740
  • Fax: 212-939-2759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number185783
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: