Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 298260-1 | NY |
NPI | 1013398684 |
---|---|
Provider Name | Mrs. Galyna Fetsak |
First Address | Ridgewood, NY 11385-1323 |
Second Address | Mineola, NY 11501-3957 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2015 |
Last Update Date | 24/09/2019 |