Individual
IANA NIKOLAEVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
704 AVENUE X FL 2, BROOKLYN, NY 11235-6121
(718) 676-6116
Mailing address
1589 E 14TH ST, BROOKLYN, NY 11230-7103
(718) 350-7020
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
NY
Other
Enumeration date
11/06/2023
Last updated
11/06/2023
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