Dariko Danielyan
Individual provider Active NPI Speech-Language Pathologist · Suite 1, NJ
NPI 1831810951 · NPPES record last updated Sep 7, 2022
Key facts
- NPI
- 1831810951
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- TL-3940 (NJ)
- Practice address
- 751 NJ-73
Suite 1, NJ 08053 - Phone
- (856) 375-2914
- NPI assigned
- Sep 7, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231114001231 | NJ | Practitioner - Qualified Speech Language Pathologist | 1658728571 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TL-3940 | NJ | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| MJ Kidz LLC | Speech-Language Pathologist | Current |
Accepting new patients |
Locations
900 Haddon Ave
Ste 202
Collingswood, NJ 08108
751 Route 73 N
Ste 1
Marlton, NJ 08053
Phone (856) 823-1793
617 Auburn Ave
Ste 103
Swedesboro, NJ 08085
Phone (856) 467-6107
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | TL-3940 | NJ | Yes |
Addresses
Primary practice location
751 NJ-73
Suite 1, NJ 08053
Mailing address
188 Sycamore Ave
Marlton, NJ 08053
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 7, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.