Individual
BELLA MANAKHIMOVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
382 MAIN ST, PORT WASHINGTON, NY 11050-3181
(516) 767-7216
Mailing address
382 MAIN STREET, PORT WASHINGTON, NY 11050-3633
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
JXB78947V01
—
NY
Enumeration date
06/09/2015
Last updated
01/09/2017
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