Individual
KAYLAN PUSTOVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
4 W 58TH ST FL 13, NEW YORK, NY 10019-2515
(212) 431-4749
Mailing address
4 W 58TH ST FL 13, NEW YORK, NY 10019-2515
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
293128
NY
207N00000X
Dermatology Physician
5101021933
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
293128
NY LICENSE
NY
Enumeration date
07/31/2014
Last updated
02/11/2021
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