MEDICARE: INNA VINOKUROV

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	225XP0019X	Physical Rehabilitation Occupational Therapist	015839	NY
2	225XP0200X	Pediatric Occupational Therapist	015839	NY

General Provider Information

NPI Number	:	1972830578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INNA VINOKUROV

Provider Business Mailing Address
First Line	:	2615 AVENUE O APT 3J
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-5221
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2615 AVENUE O APT 3J
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-5221
Country	:	US
Telephone Number	:	646-734-2869
Fax Number	:

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

Provider Enumeration Date	:	11/03/2009
Last Update Date	:	11/03/2009

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Directions to “ INNA VINOKUROV ” Practice Location

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