Provider Demographics
NPI:1902419344
Name:BOBKO, DARIYA
Entity Type:Individual
Prefix:
First Name:DARIYA
Middle Name:
Last Name:BOBKO
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 1:3235 EMMONS AVE APT 308
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1133
Mailing Address - Country:US
Mailing Address - Phone:646-338-0532
Mailing Address - Fax:
Practice Address - Street 1:3235 EMMONS AVE APT 308
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-1133
Practice Address - Country:US
Practice Address - Phone:646-338-0532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309806363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health