Provider Demographics
NPI:1689116576
Name:FAKTOROVICH, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:FAKTOROVICH
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 1:314 67TH ST APT 1L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-5349
Mailing Address - Country:US
Mailing Address - Phone:917-808-3106
Mailing Address - Fax:
Practice Address - Street 1:314 67TH ST APT 1L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-5349
Practice Address - Country:US
Practice Address - Phone:917-808-3106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist