Individual
IANINA SUPONITSKY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGNP
Contact information
Practice address
1773 E 12TH ST, #4D, BROOKLYN, NY 11229-1051
(347) 713-3023
(718) 208-4022
Mailing address
PO BOX 290421, BROOKLYN, NY 11229-0421
(347) 713-3023
(718) 208-4022
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F307084-1
NY
Other
Enumeration date
05/19/2015
Last updated
09/22/2020
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