MEDICARE: MRS. ALLA PALKINA

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	156FX1800X	Optician	007375	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699788711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALLA PALKINA

Provider Business Mailing Address
First Line	:	2060 OCEAN AVENUE
Second Line	:	APT 1G
City	:	BROOKLYN
State	:	NY
Zip	:	11230
Country	:	US
Telephone Number	:	718-998-2466
Fax Number	:

Provider Business Practice Location Address
First Line	:	2167 86 ST
Second Line	:	COHENS FASHION OPTICAL
City	:	BROOKLYN
State	:	NY
Zip	:	11214-3205
Country	:	US
Telephone Number	:	718-946-3647
Fax Number	:

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

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	07/08/2007

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