Provider Demographics
NPI:1346634763
Name:GORELOV, HANNA
Entity Type:Individual
Prefix:MRS
First Name:HANNA
Middle Name:
Last Name:GORELOV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 DESMOND CT
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4201
Mailing Address - Country:US
Mailing Address - Phone:347-330-7202
Mailing Address - Fax:
Practice Address - Street 1:741 DESMOND CT
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-4201
Practice Address - Country:US
Practice Address - Phone:347-330-7202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist