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General NPI Number Information
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NPI Number | 1427088467
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Entity Type | Individual
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Provider Name | INNA K FACTOUROVICH MD
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Gender | Female
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 05/07/2018
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Provider Practice Location Address
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Address Line | 10-42 MITCHELL AVE
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City | BINGHAMTON
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State | NY
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Zip | 13903-1617
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Country | US
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Telephone | 607-762-2990
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Fax | 607-762-2639
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Provider Business Mailing Address
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Address Line | 43 SAN MARCO DR
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City | JOHNSON CITY
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State | NY
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Zip | 13790-5017
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Country | US
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Telephone | 607-761-6168
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Fax | 607-729-7955
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 233924
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License Number State | NY
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