Provider Demographics
NPI:1679134977
Name:FOSTIK, NINA
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:FOSTIK
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 1:2239 HYLAN BLVD STE 2B
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-3200
Mailing Address - Country:US
Mailing Address - Phone:718-351-8100
Mailing Address - Fax:718-351-8104
Practice Address - Street 1:2239 HYLAN BLVD STE 2B
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-3200
Practice Address - Country:US
Practice Address - Phone:718-351-8100
Practice Address - Fax:718-351-8104
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies