Healthcare Provider Details

I. General information

NPI: 1174771810
Provider Name (Legal Business Name): MARIYA ARONOVA RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2008
Last Update Date: 01/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 SCHENECTADY AVE
BROOKLYN NY
11203-1809
US

IV. Provider business mailing address

7901 BROADWAY APT 207
ELMHURST NY
11373-1329
US

V. Phone/Fax

Practice location:
  • Phone: 718-604-5000
  • Fax:
Mailing address:
  • Phone: 718-334-2555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number012698
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: