Provider Demographics
NPI:1164853263
Name:MIRZOYAN, KARINE (MSED)
Entity Type:Individual
Prefix:
First Name:KARINE
Middle Name:
Last Name:MIRZOYAN
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SHORE BLVD APT 4K
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4025
Mailing Address - Country:US
Mailing Address - Phone:646-334-4322
Mailing Address - Fax:
Practice Address - Street 1:10 SHORE BLVD APT 4K
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-4025
Practice Address - Country:US
Practice Address - Phone:646-334-4322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-28
Last Update Date:2013-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1152066252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1152066OtherCERTIFICATE NUMBER