Provider Demographics
NPI:1376032284
Name:SIMONIAN, TALIN
Entity Type:Individual
Prefix:MS
First Name:TALIN
Middle Name:
Last Name:SIMONIAN
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 1:20 ALEXANDER AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3141
Mailing Address - Country:US
Mailing Address - Phone:646-300-5689
Mailing Address - Fax:201-488-5556
Practice Address - Street 1:20 ALEXANDER AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3141
Practice Address - Country:US
Practice Address - Phone:646-300-5689
Practice Address - Fax:201-488-5556
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00946800235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist