Provider Demographics
NPI:1164774626
Name:ARUSHANOVA, MARIETA R (MS SP EDUCATION)
Entity Type:Individual
Prefix:MRS
First Name:MARIETA
Middle Name:R
Last Name:ARUSHANOVA
Suffix:
Gender:F
Credentials:MS SP EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 E 23RD ST
Mailing Address - Street 2:FL 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2511
Mailing Address - Country:US
Mailing Address - Phone:347-416-2446
Mailing Address - Fax:
Practice Address - Street 1:2420 EAST 23 STREET
Practice Address - Street 2:FL 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235
Practice Address - Country:US
Practice Address - Phone:347-416-2446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1128502174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist