Individual
MR. ALEKSANDR YEGOROV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
89 BARTLETT ST FL 2, BROOKLYN, NY 11206-4463
(718) 828-2666
Mailing address
4247 BEDFORD AVE, BROOKLYN, NY 11229-4912
(718) 909-2049
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
315033
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
866020727
DRIVER LICENSE
NY
Enumeration date
05/19/2019
Last updated
05/19/2019
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