Individual
RAISA NOVOFASTOVSKY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1812 QUENTIN RD, SUITE M-2, BROOKLYN, NY 11229-1336
(718) 382-1773
(718) 382-3214
Mailing address
1812 QUENTIN RD, SUITE M-2, BROOKLYN, NY 11229-1336
(718) 382-1773
(718) 382-3214
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
N 004903
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01250811
—
NY
01
—
214483P
HIP
—
01
—
P3603491
OXFORD
NY
Enumeration date
02/09/2006
Last updated
08/19/2013
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