Healthcare Provider Details

I. General information

NPI: 1689850091
Provider Name (Legal Business Name): INAIDA KUTSOVSKAYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 3RD AVE
NEW YORK NY
10003-5509
US

IV. Provider business mailing address

123 3RD AVE
NEW YORK NY
10003-5509
US

V. Phone/Fax

Practice location:
  • Phone: 212-529-7140
  • Fax: 212-529-7145
Mailing address:
  • Phone: 212-529-7140
  • Fax: 212-529-7145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number047430
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: