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General NPI Number Information
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NPI Number | 1699372409
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Entity Type | Individual
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Provider Name | NETANEL SHIMONOV C. PED
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Gender | Male
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Dates
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Enumeration Date | 10/05/2020
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Last Update Date | 10/05/2020
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Provider Practice Location Address
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Address Line | 1353 45TH ST
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City | BROOKLYN
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State | NY
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Zip | 11219-2102
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Country | US
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Telephone | 929-810-4777
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Fax |
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Provider Business Mailing Address
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Address Line | 1353 45TH ST
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City | BROOKLYN
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State | NY
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Zip | 11219-2102
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Country | US
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Telephone | 929-810-4777
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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 | 224L00000X
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Taxonomy Name | Pedorthist
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License Number |
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License Number State |
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