Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | F001922 | NY |
NPI | 1013561240 |
---|---|
Provider Name | Mrs. Alexandra Lara Moskaluk |
First Address | Brooklyn, NY 11209 |
Second Address | Brooklyn, NY 11215-3003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2019 |
Last Update Date | 23/08/2019 |