MEDICARE: BOULAT KITAEV

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	623253	NY

General Provider Information

NPI Number	:	1598163545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BOULAT KITAEV

Provider Business Mailing Address
First Line	:	2333 E 22ND ST APT 2F
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4830
Country	:	US
Telephone Number	:	917-302-6670
Fax Number	:	347-702-9687

Provider Business Practice Location Address
First Line	:	2333 E 22ND ST APT 2F
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4830
Country	:	US
Telephone Number	:	917-302-6670
Fax Number	:	347-702-9687

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2014
Last Update Date	:	02/14/2018

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Directions to “ BOULAT KITAEV ” Practice Location

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