Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 0497001 | NY |
NPI | 1528066339 |
---|---|
Provider Name | Lyubov Mashkabova |
First Address | Jamaica, NY 11432-1203 |
Second Address | Arverne, NY 11692-1409 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2005 |
Last Update Date | 14/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02226488 | (05) | NY |