Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 016476-1 | NY |
NPI | 1003118985 |
---|---|
Provider Name | Irina Kushnirskaya |
First Address | Staten Island, NY 10312-5616 |
Second Address | Staten Island, NY 10312-5616 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2010 |
Last Update Date | 25/11/2010 |