Provider Demographics
NPI:1508107889
Name:BOTKNECHT, NECHAMIE
Entity Type:Individual
Prefix:
First Name:NECHAMIE
Middle Name:
Last Name:BOTKNECHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NECHAMIME
Other - Middle Name:
Other - Last Name:GERTZULIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:979 E 27TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-3727
Mailing Address - Country:US
Mailing Address - Phone:718-258-7581
Mailing Address - Fax:
Practice Address - Street 1:979 E 27TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-3727
Practice Address - Country:US
Practice Address - Phone:718-258-7581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY454612101174400000X
NY454887101174400000X
NY454611101174400000X
NY454610101174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist