Healthcare Provider Details

I. General information

NPI: 1174554661
Provider Name (Legal Business Name): NATALIA KIPERMAN AUD., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATALIA GRANOVSKAYA

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 01/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 CHESTNUT ST STE 200
PHILADELPHIA PA
19103-4634
US

IV. Provider business mailing address

2200 BENJAMIN FRANKLIN PKWY #E1611
PHILADELPHIA PA
19130-3601
US

V. Phone/Fax

Practice location:
  • Phone: 215-561-0106
  • Fax:
Mailing address:
  • Phone: 917-696-9588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAT006022
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: