Individual
EKATERINA BOLOSOVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
5701 4TH AVE, BROOKLYN, NY 11220-3315
(718) 567-2800
Mailing address
5701 4TH AVE, BROOKLYN, NY 11220-3315
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
308168
NY
Other
Enumeration date
12/05/2019
Last updated
12/05/2019
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