Provider Demographics
NPI:1609552868
Name:OKTORINA, VINI
Entity Type:Individual
Prefix:
First Name:VINI
Middle Name:
Last Name:OKTORINA
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 1:6264 SAUNDERS ST APT N1
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1508
Mailing Address - Country:US
Mailing Address - Phone:347-476-8447
Mailing Address - Fax:
Practice Address - Street 1:6264 SAUNDERS ST APT N1
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1508
Practice Address - Country:US
Practice Address - Phone:347-476-8447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2870962174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist