MEDICARE: ANNA FAKTOROVICH

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

General Provider Information

NPI Number	:	1689116576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA FAKTOROVICH

Provider Business Mailing Address
First Line	:	314 67TH ST APT 1L
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-5349
Country	:	US
Telephone Number	:	917-808-3106
Fax Number	:

Provider Business Practice Location Address
First Line	:	314 67TH ST APT 1L
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-5349
Country	:	US
Telephone Number	:	917-808-3106
Fax Number	:

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

Provider Enumeration Date	:	11/09/2016
Last Update Date	:	11/09/2016

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Directions to “ ANNA FAKTOROVICH ” Practice Location

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