Provider Demographics
NPI:1134113582
Name:OHANIAN, HERIPSIME
Entity Type:Individual
Prefix:
First Name:HERIPSIME
Middle Name:
Last Name:OHANIAN
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 1:1 KALISA WAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-3516
Mailing Address - Country:US
Mailing Address - Phone:201-265-9042
Mailing Address - Fax:201-265-1682
Practice Address - Street 1:1 KALISA WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-3516
Practice Address - Country:US
Practice Address - Phone:201-265-9042
Practice Address - Fax:201-265-1682
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05134100174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0K2562OtherHEALTHNET #
NJ491391OtherAETNA PPO #
NJ0031726OtherGHI PPO#
NJBP432OtherOXFORD #
NJ5303702Medicaid
NJ0537961000OtherAMERIHEALTH #
NJ30H952OtherEMPIRE BC/BS #
NJ557549OtherAETNA HMO #
NJ21153OtherUHP #
NJ001436Medicare PIN
NJ21153OtherUHP #