Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | CFTS0152 | NY |
NPI | 1568655454 |
---|---|
Provider Name | Alex Iskhakov |
First Address | Brooklyn, NY 11218-5804 |
Second Address | Brooklyn, NY 11218-5804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2007 |
Last Update Date | 23/08/2007 |