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General NPI Number Information
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NPI Number | 1124382528
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Entity Type | Individual
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Provider Name | KSENIYA SOSUNOVA MSED
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Gender | Female
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Dates
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Enumeration Date | 06/29/2012
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Last Update Date | 04/03/2016
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Provider Practice Location Address
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Address Line | 6625 103RD ST APT 4G
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City | FOREST HILLS
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State | NY
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Zip | 11375-2001
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Country | US
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Telephone | 917-699-6224
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Fax |
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Provider Business Mailing Address
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Address Line | 6625 103RD ST APT 4G
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City | FOREST HILLS
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State | NY
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Zip | 11375-2001
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Country | US
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Telephone | 917-699-6224
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 567820111
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 567823111
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License Number State | NY
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