MEDICARE: MARINA BALYKOVA

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	224Z00000X	Occupational Therapy Assistant	008418-1	NY

General Provider Information

NPI Number	:	1194360586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARINA BALYKOVA

Provider Business Mailing Address
First Line	:	3847 NEPTUNE AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-1327
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3847 NEPTUNE AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-1327
Country	:	US
Telephone Number	:	646-750-8892
Fax Number	:

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

Provider Enumeration Date	:	11/09/2019
Last Update Date	:	11/09/2019

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Directions to “ MARINA BALYKOVA ” Practice Location

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