Provider Demographics
NPI:1942431705
Name:KORYTNAYA, MILANA (OTA)
Entity Type:Individual
Prefix:
First Name:MILANA
Middle Name:
Last Name:KORYTNAYA
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2026 OCEAN AVE APT 3C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-7326
Mailing Address - Country:US
Mailing Address - Phone:646-541-7754
Mailing Address - Fax:
Practice Address - Street 1:2026 OCEAN AVE APT 3C
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-7326
Practice Address - Country:US
Practice Address - Phone:646-541-7754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006850171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor