Provider Demographics
NPI:1548696263
Name:KHOSHBAKHSH, ARIELLA
Entity type:Individual
Prefix:
First Name:ARIELLA
Middle Name:
Last Name:KHOSHBAKHSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT 3298
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60132-3298
Mailing Address - Country:US
Mailing Address - Phone:561-478-8770
Mailing Address - Fax:561-598-7231
Practice Address - Street 1:420 LEXINGTON AVE
Practice Address - Street 2:SUITE 315
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10170-0315
Practice Address - Country:US
Practice Address - Phone:212-867-6337
Practice Address - Fax:212-867-6506
Is Sole Proprietor?:No
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000035128237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist