MEDICARE: IZABELLA MULLOKANDOV MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207U00000X	Nuclear Medicine Physician	206986	NY

General Provider Information

NPI Number	:	1023119229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IZABELLA MULLOKANDOV MD

Provider Business Mailing Address
First Line	:	ONE BROOKDALE PLAZA, BROOKDALE HOSPITAL, RADIOLOGY
Second Line	:	ROOM #309
City	:	BROOKLYN
State	:	NY
Zip	:	11212-3198
Country	:	US
Telephone Number	:	718-240-5425
Fax Number	:	718-240-6620

Provider Business Practice Location Address
First Line	:	ONE BROOKDALE PLAZA, BROOKDALE HOSPITAL, RADIOLOGY
Second Line	:	ROOM #309
City	:	BROOKLYN
State	:	NY
Zip	:	11212-3198
Country	:	US
Telephone Number	:	718-240-5425
Fax Number	:	718-240-6620

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	09/03/2024

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