Healthcare Provider Details

I. General information

NPI: 1528531753
Provider Name (Legal Business Name): ALLA PRYSYAZHNYUK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 01/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3066 BRIGHTON 4TH ST APT 301
BROOKLYN NY
11235-6587
US

IV. Provider business mailing address

3066 BRIGHTON 4TH ST APT 301
BROOKLYN NY
11235-6587
US

V. Phone/Fax

Practice location:
  • Phone: 917-780-0424
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number695230
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: