Provider Demographics
NPI:1689937815
Name:VOICHUK, DORA (MSED)
Entity Type:Individual
Prefix:MS
First Name:DORA
Middle Name:
Last Name:VOICHUK
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:MS
Other - First Name:DORA
Other - Middle Name:
Other - Last Name:EISENSTADT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2785 W 5TH ST
Mailing Address - Street 2:APPT.2D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-4629
Mailing Address - Country:US
Mailing Address - Phone:718-872-5945
Mailing Address - Fax:718-872-5945
Practice Address - Street 1:2785 W 5TH ST
Practice Address - Street 2:APPT. 2D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-4629
Practice Address - Country:US
Practice Address - Phone:718-872-5945
Practice Address - Fax:718-872-5945
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY963672001174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY252Y00000XOtherEARLY INTERVENTION PROVIDER AGENCY