Provider Demographics
NPI:1750745089
Name:MIRIAN, PHILLIP ARASH (DPT)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:ARASH
Last Name:MIRIAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 50TH AVE
Mailing Address - Street 2:16K
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-5824
Mailing Address - Country:US
Mailing Address - Phone:515-988-5231
Mailing Address - Fax:
Practice Address - Street 1:62 E 88TH ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1151
Practice Address - Country:US
Practice Address - Phone:212-988-2501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62039810225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist