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General NPI Number Information
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NPI Number | 1871157396
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Entity Type | Organization
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Legal Business Name | BAD NOODLE, LLC
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Dates
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Enumeration Date | 04/30/2019
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Last Update Date | 04/30/2019
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Provider Practice Location Address
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Address Line | 865 W END AVE APT 1A
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City | NEW YORK
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State | NY
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Zip | 10025-8402
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Country | US
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Telephone | 347-443-9318
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Fax |
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Provider Business Mailing Address
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Address Line | 127 W 95TH ST APT 2
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City | NEW YORK
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State | NY
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Zip | 10025-6639
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Country | US
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Telephone | 347-443-9318
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. MASHA BOROVIKOVA ARMYN
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Credential | PHD
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Telephone | 347-443-9318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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