Provider Demographics
NPI:1063845337
Name:FOURMAN, ARIELLE R
Entity Type:Individual
Prefix:
First Name:ARIELLE
Middle Name:R
Last Name:FOURMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 E 63RD ST APT 10C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7988
Mailing Address - Country:US
Mailing Address - Phone:631-219-6375
Mailing Address - Fax:
Practice Address - Street 1:1940 PALMER AVE # 1017
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-2410
Practice Address - Country:US
Practice Address - Phone:631-219-6375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-09
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
PASL012004235Z00000X
NY023852235Z00000X
MA77745-SP-SL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty