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Individual

EKATERINA POTAPOVA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1991 MARCUS AVE, LAKE SUCCESS, NY 11042
(516) 442-2250
Mailing address
1991 MARCUS AVE, NEW HYDE PARK, NY 11042-2057
(516) 442-2250

Taxonomy

Speciality
Code
Description
License number
State
156F00000X
Technician/Technologist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
3245
CNIM
Enumeration date
06/15/2017
Last updated
07/21/2022
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