Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | N005977 | NY |
Y | 222Z00000X | Podiatrist | N005977 | NY |
NPI | 1073529731 |
---|---|
Provider Name | Oleg Latvinsky |
First Address | Brooklyn, NY 11234-6424 |
Second Address | Brooklyn, NY 11224-2005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 28/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02553735 | (05) | NY |
U98894 | (02) | NY |