Healthcare Provider Details

I. General information

NPI: 1578159968
Provider Name (Legal Business Name): NADEJDA TIHOMIROVS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2020
Last Update Date: 12/19/2020
Certification Date: 12/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 OCEAN PKWY STE L1
BROOKLYN NY
11235-8344
US

IV. Provider business mailing address

155 OCEANA DR E APT 2E
BROOKLYN NY
11235-6684
US

V. Phone/Fax

Practice location:
  • Phone: 718-283-4444
  • Fax:
Mailing address:
  • Phone: 917-922-0929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number3110044
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: