Provider Demographics
NPI:1336974625
Name:ATBASHYAN, MARINA VAYNERMAN
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:VAYNERMAN
Last Name:ATBASHYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARINA
Other - Middle Name:
Other - Last Name:VAYNERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:260 WHITMAN DR
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6932
Mailing Address - Country:US
Mailing Address - Phone:646-239-8282
Mailing Address - Fax:
Practice Address - Street 1:260 WHITMAN DR
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-6932
Practice Address - Country:US
Practice Address - Phone:646-239-8282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4338357174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty