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General NPI Number Information
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NPI Number | 1063645687
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Entity Type | Individual
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Provider Name | INGA KORNITSKY PA
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Gender | Female
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Dates
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Enumeration Date | 08/30/2009
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Last Update Date | 08/30/2009
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Provider Practice Location Address
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Address Line | 2601 OCEAN PKWY
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City | BROOKLYN
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State | NY
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Zip | 11235-7745
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Country | US
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Telephone | 171-861-6438
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Fax |
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Provider Business Mailing Address
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Address Line | 93 LONGWOOD DR
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City | ATHENS
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State | NY
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Zip | 12015-2700
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Country | US
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Telephone | 516-567-1663
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 003378-1
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License Number State | NY
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