MEDICARE: NELLI KONDRATYUK RN

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	163W00000X	Registered Nurse	636236	NY

General Provider Information

NPI Number	:	1811257959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NELLI KONDRATYUK RN

Provider Business Mailing Address
First Line	:	3699 SHORE PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-1649
Country	:	US
Telephone Number	:	347-702-4740
Fax Number	:	347-702-7243

Provider Business Practice Location Address
First Line	:	1338 E 69TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5703
Country	:	US
Telephone Number	:	718-251-1231
Fax Number	:	347-702-7243

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

Provider Enumeration Date	:	05/23/2012
Last Update Date	:	05/23/2012

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