Individual
ALINA FEDOROV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
457 ADAMS AVE, STATEN ISLAND, NY 10306-5422
(347) 631-5441
Mailing address
457 ADAMS AVE, STATEN ISLAND, NY 10306-5422
(347) 631-5441
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
2873123
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
256327544
NYS DMV
NY
Enumeration date
09/29/2020
Last updated
09/29/2020
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