Individual
DIANA NEKTALOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
3900 SHORE PKWY, BROOKLYN, NY 11235-1130
(718) 891-0680
(718) 891-0681
Mailing address
3900 SHORE PKWY, BROOKLYN, NY 11235-1130
(718) 891-0680
(718) 891-0681
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
016792
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
WEX981
MEDICARE GROUP PROVIDER
NY
Enumeration date
06/27/2012
Last updated
06/27/2012
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