Individual
MS. MINI POTHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7603 113TH ST, SUITE M6, FOREST HILLS, NY 11375-6530
(718) 268-1100
(718) 263-6418
Mailing address
16215 78TH AVE, FLUSHING, NY 11366-1911
(718) 591-7054
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
016036
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02797560
—
NY
Enumeration date
09/21/2006
Last updated
07/27/2007
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