Healthcare Provider Details

I. General information

NPI: 1528408382
Provider Name (Legal Business Name): BELLA MILOVA RT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 12/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 E 23RD ST
NEW YORK NY
10010-5011
US

IV. Provider business mailing address

111 JOHN ST STE 1120
NEW YORK NY
10038-3101
US

V. Phone/Fax

Practice location:
  • Phone: 212-686-7500
  • Fax:
Mailing address:
  • Phone: 212-766-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number615605
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: