Healthcare Provider Details

I. General information

NPI: 1396140711
Provider Name (Legal Business Name): ALLA KHLEBNIKOVA RN.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2014
Last Update Date: 10/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 WASHINGTON AVENUE
SUFFERN NY
10901
US

IV. Provider business mailing address

99 WASHINGTON AVENUE
SUFFERN NY
10901
US

V. Phone/Fax

Practice location:
  • Phone: 845-357-4500
  • Fax:
Mailing address:
  • Phone: 845-357-4500
  • Fax: 845-357-5039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number671726
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: