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NPI Code Detail

MEDICARE: ANNA ZOLOTAREV

MEDICARE: ANNA ZOLOTAREV
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
1252Y00000XEarly Intervention Provider Agency
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1073137600
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNA ZOLOTAREV
Provider Business Mailing Address
First Line : 192 PEMBROOK LOOP
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10309-1817
Country : US
Telephone Number : 646-498-3193
Fax Number :
Provider Business Practice Location Address
First Line : 192 PEMBROOK LOOP
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10309-1817
Country : US
Telephone Number : 646-498-3193
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2020
Last Update Date : 05/29/2020

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Directions to “ ANNA ZOLOTAREV ” Practice Location

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