Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 206986 | NY |
NPI | 1023119229 |
---|---|
Provider Name | Izabella Mullokandov |
First Address | Brooklyn, NY 11212-3198 |
Second Address | Brooklyn, NY 11212-3198 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 08/07/2007 |