Raisa Gavrielova
Specialist in Brooklyn, NY. Individual provider (NPI-1).
NPI number1861862575
StatusActive
Last updated in NPPESOct 7, 2015
Details
- NPI
- 1861862575
- Entity type
- Individual (NPI-1)
- Name
- Raisa Gavrielova
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Oct 7, 2015
- Last updated
- Oct 7, 2015
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 174400000X | Specialist | – | NY | Yes |
Practice location
1312 38th StBrooklyn, NY 11218-3612
Phone 718-686-3700
Mailing address
1312 38th StBrooklyn, NY 11218-3612
Phone 718-686-3700
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