Individual
CHANNY BAKST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
785 CAFFREY AVE, FAR ROCKAWAY, NY 11691-5301
(718) 327-7174
Mailing address
785 CAFFREY AVE, FAR ROCKAWAY, NY 11691-5301
(718) 327-7174
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
09/06/2011
Last updated
09/06/2011
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