1639597743 NPI number — GOHARIK AZARIAN M.S. CCC/SLP

Table of content: GOHARIK AZARIAN M.S. CCC/SLP (NPI 1639597743)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639597743 NPI number — GOHARIK AZARIAN M.S. CCC/SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AZARIAN
Provider First Name:
GOHARIK
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S. CCC/SLP
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:
1639597743
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
TELEMEDICINE SERVICES
Provider Second Line Business Mailing Address:
16 RUSSELL HILL ROAD
Provider Business Mailing Address City Name:
BROOKLINE
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-573-3349
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16 RUSSELL HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLINE
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03033-2103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-573-3349
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/04/2014

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: 235Z00000X , with the licence number:  9004 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 30696 . This is a "CALIFORNIA-SPEECH LANGUAGE PATHOLOGY-AUDIOLOGY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 9004 . This is a "MASSACHUSETTS SPEECH LANGUAGE PATHOLOGY-AUDIOLOGY BOARD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 028103 . This is a "NEW YORK SPEECH-LANGUAGE PATHOLOGY-AUDIOLOGY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 14094086 . This is a "AMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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