Provider Demographics
NPI:1912537564
Name:NAIRA AMBARIAN MEDICAL PC
Entity Type:Organization
Organization Name:NAIRA AMBARIAN MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NAIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMBARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:917-676-3932
Mailing Address - Street 1:107 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4311
Mailing Address - Country:US
Mailing Address - Phone:929-318-9281
Mailing Address - Fax:347-556-4558
Practice Address - Street 1:107 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4311
Practice Address - Country:US
Practice Address - Phone:917-676-3932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-23
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & NeuropsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY257030OtherLISCENCE