Provider Demographics
NPI:1467549832
Name:OUNDJIAN, NELLY JOUAYED (MD)
Entity Type:Individual
Prefix:DR
First Name:NELLY
Middle Name:JOUAYED
Last Name:OUNDJIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NELLY
Other - Middle Name:
Other - Last Name:JOUAYED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:506 MALCOLM X BLVD
Mailing Address - Street 2:WP-522
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-1802
Mailing Address - Country:US
Mailing Address - Phone:212-939-2740
Mailing Address - Fax:212-939-2759
Practice Address - Street 1:34 RIPPLEWOOD DR
Practice Address - Street 2:
Practice Address - City:UPPER SADDLE RIVER
Practice Address - State:NJ
Practice Address - Zip Code:07458-1410
Practice Address - Country:US
Practice Address - Phone:201-825-0464
Practice Address - Fax:201-825-0464
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185783208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01361917Medicaid