Individual
LIZA YEFIMOVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
578 TRAVIS AVE, STATEN ISLAND, NY 10314-4802
(646) 578-0612
Mailing address
578 TRAVIS AVE, STATEN ISLAND, NY 10314-4802
(646) 578-0612
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
251300000X
—
NY
Enumeration date
05/31/2017
Last updated
05/31/2017
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