Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 280607 | NY |
Y | 213ES0000X | Sports Medicine | 280607 | NY |
NPI | 1215341748 |
---|---|
Provider Name | Emily Nell Fatakhov |
First Address | New York, NY 10029-6528 |
Second Address | New York, NY 10029-6528 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2014 |
Last Update Date | 18/10/2019 |