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General NPI Number Information
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NPI Number | 1033632823
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Entity Type | Individual
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Provider Name | JANET LEAH IZRAILOVA OD
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Gender | Female
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Dates
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Enumeration Date | 07/24/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 10306 ROOSEVELT AVE
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City | CORONA
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State | NY
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Zip | 11368-2330
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Country | US
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Telephone | 718-424-1333
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Fax |
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Provider Business Mailing Address
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Address Line | 9952 64TH AVE
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City | REGO PARK
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State | NY
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Zip | 11374-2645
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Country | US
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Telephone | 718-997-8523
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV008610-1
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License Number State | NY
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