Individual
ALLA KAPUSTINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
259 1ST ST, MINEOLA, NY 11501-3957
(516) 663-0333
Mailing address
144 BAISLEY AVE, EAST ROCKAWAY, NY 11518-1824
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
3747A0650X
Attendant Care Provider
—
—
Other
Enumeration date
07/28/2019
Last updated
07/29/2019
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