Healthcare Provider Details

I. General information

NPI: 1033472550
Provider Name (Legal Business Name): BOGDANA KOTLYAR MS.SPECIAL EDUCATION
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 06/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 W 4TH ST APT D6
BROOKLYN NY
11204-4023
US

IV. Provider business mailing address

1411 W 4TH ST APT D6
BROOKLYN NY
11204-4023
US

V. Phone/Fax

Practice location:
  • Phone: 917-498-3853
  • Fax:
Mailing address:
  • Phone: 917-498-3853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1834050
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: