Healthcare Provider Details

I. General information

NPI: 1407363278
Provider Name (Legal Business Name): OLIVIA OHANIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2018
Last Update Date: 01/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 ROUTE 9W
PIERMONT NY
10968-1116
US

IV. Provider business mailing address

561 ROUTE 9W
PIERMONT NY
10968-1116
US

V. Phone/Fax

Practice location:
  • Phone: 845-680-1420
  • Fax:
Mailing address:
  • Phone: 845-680-1420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1194496171
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: