Provider Demographics
NPI:1497191258
Name:PROKOPTCHIK, RITA (RN)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:PROKOPTCHIK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1664 E 14TH ST STE 401
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1169
Mailing Address - Country:US
Mailing Address - Phone:718-375-2300
Mailing Address - Fax:718-513-6322
Practice Address - Street 1:1664 E 14TH ST STE 401
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1169
Practice Address - Country:US
Practice Address - Phone:718-375-2300
Practice Address - Fax:888-506-2272
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY659992163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse