Healthcare Provider Details

I. General information

NPI: 1831473107
Provider Name (Legal Business Name): MS. ANNA KOBYCHEVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2011
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 NOSTRAND AVENUE 2 ND FLOOR
BROOKLYN NY
11226-7181
US

IV. Provider business mailing address

901 AVENUE H APT 6 L
BROOKLYN NY
11230
US

V. Phone/Fax

Practice location:
  • Phone: 718-421-4224
  • Fax: 718-421-4774
Mailing address:
  • Phone: 347-399-1854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number7055953
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: