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General NPI Number Information
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NPI Number | 1164774626
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Entity Type | Individual
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Provider Name | MARIETA R ARUSHANOVA MS. SP EDUCATION
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Gender | Female
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Dates
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Enumeration Date | 10/09/2012
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Last Update Date | 10/09/2012
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Provider Practice Location Address
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Address Line | 2420 EAST 23 STREET FL 1
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City | BROOKLYN
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State | NY
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Zip | 11235
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Country | US
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Telephone | 347-416-2446
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Fax |
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Provider Business Mailing Address
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Address Line | 2420 E 23RD ST FL 1
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City | BROOKLYN
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State | NY
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Zip | 11235-2511
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Country | US
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Telephone | 347-416-2446
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1128502
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License Number State | NY
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