Healthcare Provider Details

I. General information

NPI: 1447498860
Provider Name (Legal Business Name): NADA ANNA KHODL MA ADTR LCAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2009
Last Update Date: 01/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 CUMMING ST 3D
NEW YORK NY
10034-4805
US

IV. Provider business mailing address

19 CUMMING ST 3D
NEW YORK NY
10034-4805
US

V. Phone/Fax

Practice location:
  • Phone: 212-304-3646
  • Fax:
Mailing address:
  • Phone: 212-304-3646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225600000X
TaxonomyDance Therapist
License Number000421
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: