Provider Demographics
NPI:1629278700
Name:ARUMOVA, TATYANA (OTA)
Entity Type:Individual
Prefix:MS
First Name:TATYANA
Middle Name:
Last Name:ARUMOVA
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:TATYANA
Other - Middle Name:
Other - Last Name:ARUMOVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTA
Mailing Address - Street 1:85 DIAMOND AVE
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-3402
Mailing Address - Country:US
Mailing Address - Phone:516-520-3104
Mailing Address - Fax:
Practice Address - Street 1:85 DIAMOND AVE
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-3402
Practice Address - Country:US
Practice Address - Phone:516-520-3104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004271320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities