MEDICARE: IGOR MOLCHADSKIY

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	164W00000X	Licensed Practical Nurse	308258	NY

General Provider Information

NPI Number	:	1730466400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IGOR MOLCHADSKIY

Provider Business Mailing Address
First Line	:	3118 BRIGHTON 4TH ST APT 3F
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-7251
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3118 BRIGHTON 4TH ST APT 3F
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-7251
Country	:	US
Telephone Number	:	347-532-0545
Fax Number	:

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

Provider Enumeration Date	:	11/09/2011
Last Update Date	:	11/09/2011

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