MEDICARE: NATALIYA VINOKUR M.S/B.S IN OT

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	174400000X	Specialist	015286-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	931993407	OTHER	NY	GHI

General Provider Information

NPI Number	:	1649500992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIYA VINOKUR M.S/B.S IN OT

Provider Business Mailing Address
First Line	:	25 BAY TER
Second Line	:	14 B
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-3637
Country	:	US
Telephone Number	:	917-318-4798
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 BAY TER
Second Line	:	14 B
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-3637
Country	:	US
Telephone Number	:	917-318-4798
Fax Number	:

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

Provider Enumeration Date	:	01/09/2010
Last Update Date	:	01/09/2010

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