=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154036424
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MET TEK EI INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2023
-----------------------------------------------------
Last Update Date | 01/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2954 W 8TH ST APT 20B
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11224-3220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-971-7728
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2954 W 8TH ST APT 20B
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11224-3220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-971-7728
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPECIAL EDUCATION TEACHER
-----------------------------------------------------
Name | IGOR LOBKOV
-----------------------------------------------------
Credential | MS.ED
-----------------------------------------------------
Telephone | 917-971-7728
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------