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General NPI Number Information
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NPI Number | 1154827616
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Entity Type | Individual
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Provider Name | MARINA BUKHRASHVILI
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Gender | Female
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Dates
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Enumeration Date | 04/03/2018
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Last Update Date | 04/03/2018
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Provider Practice Location Address
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Address Line | 4915 10TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11219-3301
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Country | US
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Telephone | 718-851-3700
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Fax |
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Provider Business Mailing Address
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Address Line | 351 W 24TH ST APT 13G
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City | NEW YORK
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State | NY
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Zip | 10011-1514
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Country | US
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Telephone |
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | F308617-1
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License Number State | NY
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