Provider Demographics
NPI:1912449133
Name:AYLEEN GREGORIAN DPM
Entity Type:Organization
Organization Name:AYLEEN GREGORIAN DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AYLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREGORIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:781-254-7093
Mailing Address - Street 1:22 PARK LN
Mailing Address - Street 2:
Mailing Address - City:HARVARD
Mailing Address - State:MA
Mailing Address - Zip Code:01451-1436
Mailing Address - Country:US
Mailing Address - Phone:781-254-7093
Mailing Address - Fax:978-456-7842
Practice Address - Street 1:22 PARK LN
Practice Address - Street 2:
Practice Address - City:HARVARD
Practice Address - State:MA
Practice Address - Zip Code:01451-1436
Practice Address - Country:US
Practice Address - Phone:781-254-7093
Practice Address - Fax:978-456-7842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2165213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0323420Medicaid
MAY75103Medicare UPIN