MEDICARE: NATALIA BACHURINA PA

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	363AM0700X	Medical Physician Assistant	015069	NY

General Provider Information

NPI Number	:	1144502956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIA BACHURINA PA

Provider Business Mailing Address
First Line	:	40 W BRIGHTON AVE
Second Line	:	SUITE 103
City	:	BROOKLYN
State	:	NY
Zip	:	11224-4902
Country	:	US
Telephone Number	:	718-743-0464
Fax Number	:	718-266-4606

Provider Business Practice Location Address
First Line	:	40 W BRIGHTON AVE
Second Line	:	SUITE 103
City	:	BROOKLYN
State	:	NY
Zip	:	11224-4902
Country	:	US
Telephone Number	:	718-743-0464
Fax Number	:	718-266-4606

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

Provider Enumeration Date	:	09/16/2011
Last Update Date	:	09/16/2011

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