Individual
DR. LADA OSIPOVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O
Contact information
Practice address
747 MONTAUK HWY, WEST ISLIP, NY 11795
(631) 321-1286
(631) 321-1379
Mailing address
747 MONTAUK HWY, WEST ISLIP, NY 11795
(631) 321-1286
(631) 321-1379
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
215517
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02160025
—
NY
01
—
50V291
BLUE CROSS
NY
Enumeration date
02/22/2006
Last updated
05/13/2009
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