Provider Demographics
NPI:1457631749
Name:LATYPOV, INESSA
Entity Type:Individual
Prefix:MRS
First Name:INESSA
Middle Name:
Last Name:LATYPOV
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 1:2840 OCEAN PKWY
Mailing Address - Street 2:APT 8 E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-7960
Mailing Address - Country:US
Mailing Address - Phone:718-434-1510
Mailing Address - Fax:
Practice Address - Street 1:2840 OCEAN PKWY
Practice Address - Street 2:APT 8 E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7960
Practice Address - Country:US
Practice Address - Phone:718-434-1510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist