Individual
KCENIA NISANOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10815 67TH DR, FOREST HILLS, NY 11375-2945
(718) 374-3302
Mailing address
10815 67TH DR, FOREST HILLS, NY 11375-2945
(718) 374-3302
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
Primary
2620731
NY
Other
Enumeration date
08/07/2014
Last updated
08/07/2014
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