Provider Demographics
NPI:1487827879
Name:BRAL, POUYA (MA,CCC-A)
Entity Type:Individual
Prefix:
First Name:POUYA
Middle Name:
Last Name:BRAL
Suffix:
Gender:F
Credentials:MA,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 PARK AVE S FL 5
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6892
Mailing Address - Country:US
Mailing Address - Phone:347-815-4327
Mailing Address - Fax:212-679-6472
Practice Address - Street 1:461 PARK AVE S FL 5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6892
Practice Address - Country:US
Practice Address - Phone:347-815-4327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001742-1237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter