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General NPI Number Information
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NPI Number | 1740694587
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Entity Type | Individual
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Provider Name | MRS. NELLI BARDANOVA
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Gender | Female
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Dates
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Enumeration Date | 06/19/2014
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Last Update Date | 01/23/2020
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Provider Practice Location Address
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Address Line | 7907 METROPOLITAN AVE
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City | MIDDLE VILLAGE
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State | NY
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Zip | 11379-2930
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Country | US
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Telephone | 917-745-0470
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Fax |
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Provider Business Mailing Address
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Address Line | 9805 63RD RD APT 5B
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City | REGO PARK
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State | NY
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Zip | 11374-1744
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Country | US
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Telephone | 917-679-2040
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 018931
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License Number State | NY
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