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General NPI Number Information
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NPI Number | 1588631345
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Entity Type | Organization
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Legal Business Name | Y FILL SLUKHINSKY
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Dates
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Enumeration Date | 03/01/2006
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 3043 OCEAN AVE SUITE 202
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City | BROOKLYN
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State | NY
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Zip | 11235-3497
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Country | US
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Telephone | 718-332-6946
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Fax |
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Provider Business Mailing Address
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Address Line | 3043 OCEAN AVE SUITE 202
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City | BROOKLYN
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State | NY
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Zip | 11235-3497
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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 | SOLE PROPRIETOR
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Name | YEKATRINA FILL SLUKHINSKY
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Credential |
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Telephone | 718-332-6946
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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 | 167572
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License Number State | NY
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