Provider Demographics
NPI:1578099651
Name:STARODUBTSEVA, NATALIA
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:
Last Name:STARODUBTSEVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NATALIYA
Other - Middle Name:
Other - Last Name:KUSHNIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2632 E 21ST ST
Mailing Address - Street 2:APT. 2B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2907
Mailing Address - Country:US
Mailing Address - Phone:646-334-2684
Mailing Address - Fax:
Practice Address - Street 1:2632 E 21ST ST
Practice Address - Street 2:APT. 2B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2907
Practice Address - Country:US
Practice Address - Phone:646-334-2684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2518101174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist