MEDICARE: DINA BARANOVA

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	174400000X	Specialist		NY

General Provider Information

NPI Number	:	1538996145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DINA BARANOVA

Provider Business Mailing Address
First Line	:	67 MCLAUGHLIN ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-4214
Country	:	US
Telephone Number	:	646-236-6902
Fax Number	:

Provider Business Practice Location Address
First Line	:	67 MCLAUGHLIN ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-4214
Country	:	US
Telephone Number	:	646-236-6902
Fax Number	:

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

Provider Enumeration Date	:	09/17/2024
Last Update Date	:	09/17/2024

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Directions to “ DINA BARANOVA ” Practice Location

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