1275896169 NPI number — MS. MARIANA ASHKINADZE MSED, SBL

Table of content: MS. MARIANA ASHKINADZE MSED, SBL (NPI 1275896169)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275896169 NPI number — MS. MARIANA ASHKINADZE MSED, SBL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ASHKINADZE
Provider First Name:
MARIANA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSED, SBL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275896169
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2465 HARING ST
Provider Second Line Business Mailing Address:
6A
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11235-1869
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-769-5406
Provider Business Mailing Address Fax Number:
347-492-3308

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2465 HARING ST
Provider Second Line Business Practice Location Address:
6A
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11235-1869
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-769-5406
Provider Business Practice Location Address Fax Number:
347-492-3308
Provider Enumeration Date:
06/17/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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