1467549832 NPI number — DR. NELLY JOUAYED OUNDJIAN MD

Table of content: DR. NELLY JOUAYED OUNDJIAN MD (NPI 1467549832)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467549832 NPI number — DR. NELLY JOUAYED OUNDJIAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OUNDJIAN
Provider First Name:
NELLY
Provider Middle Name:
JOUAYED
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOUAYED
Provider Other First Name:
NELLY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1467549832
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
506 MALCOLM X BLVD
Provider Second Line Business Mailing Address:
WP-522
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10037-1802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-939-2740
Provider Business Mailing Address Fax Number:
212-939-2759

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34 RIPPLEWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UPPER SADDLE RIVER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07458-1410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-825-0464
Provider Business Practice Location Address Fax Number:
201-825-0464
Provider Enumeration Date:
10/06/2006

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: 208000000X , with the licence number:  185783 , 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)

  • Identifier: 01361917 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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