Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | N006578 | NY |
NPI | 1275806044 |
---|---|
Provider Name | Dr. Olga Davydova |
First Address | Forest Hills, NY 11375-2751 |
Second Address | Forest Hills, NY 11375-2751 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2012 |
Last Update Date | 30/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03773939 | (05) | NY |