Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 272088 | NY |
N | 207QA0401X | Family Doctor - Addiction Medicine | 272088 | NY |
NPI | 1508184029 |
---|---|
Provider Name | Marina Andrianova |
First Address | Babylon, NY 11702-3443 |
Second Address | Babylon, NY 11702-3443 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2010 |
Last Update Date | 18/08/2015 |