Healthcare Provider Details

I. General information

NPI: 1518316488
Provider Name (Legal Business Name): FAINA SOLODAR REGISTRED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 06/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 CORBIN PL
BROOKLYN NY
11235-4804
US

IV. Provider business mailing address

84 CORBIN PL
BROOKLYN NY
11235-4804
US

V. Phone/Fax

Practice location:
  • Phone: 718-415-4262
  • Fax: 718-273-7479
Mailing address:
  • Phone: 718-415-4262
  • Fax: 718-273-7479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number5003361
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: