Healthcare Provider Details

I. General information

NPI: 1801039946
Provider Name (Legal Business Name): ARET TIKIRYAN OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2009
Last Update Date: 04/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 W END AVE 1C
NEW YORK NY
10025-3533
US

IV. Provider business mailing address

68 PERRY ST APT 1F
NEW YORK NY
10014-3281
US

V. Phone/Fax

Practice location:
  • Phone: 212-662-9200
  • Fax:
Mailing address:
  • Phone: 917-776-4180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number0103361
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: