Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 025151 | NY |
NPI | 1073115275 |
---|---|
Provider Name | Ms. Irina Andreyko |
First Address | Brooklyn, NY 11235-3131 |
Second Address | Brooklyn, NY 11235-3131 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2020 |
Last Update Date | 12/11/2020 |