Healthcare Provider Details

I. General information

NPI: 1730512609
Provider Name (Legal Business Name): NIKOLAY POPOV
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2013
Last Update Date: 08/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2879 W 12TH ST APT 9Q
BROOKLYN NY
11224-3026
US

IV. Provider business mailing address

2879 W 12TH ST APT 9Q
BROOKLYN NY
11224-3026
US

V. Phone/Fax

Practice location:
  • Phone: 843-457-2795
  • Fax:
Mailing address:
  • Phone: 843-457-2795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberNONE OF ONE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: