Individual
INNA K FACTOUROVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
10-42 MITCHELL AVE, BINGHAMTON, NY 13903-1617
(607) 762-2990
(607) 762-2639
Mailing address
43 SAN MARCO DR, JOHNSON CITY, NY 13790-5017
(607) 761-6168
(607) 729-7955
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
233924
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051110000061
FIDELIS CARE NY
NY
05
—
06000233924
—
NY
01
—
10097185
CDPHP
NY
Enumeration date
07/04/2006
Last updated
05/07/2018
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