Provider Demographics
NPI:1013466275
Name:KALANTAROVA, NADEZHDA (OD)
Entity Type:Individual
Prefix:
First Name:NADEZHDA
Middle Name:
Last Name:KALANTAROVA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14754 76TH RD
Mailing Address - Street 2:MAILBOX 2 , 2ND FLOOR
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3140
Mailing Address - Country:US
Mailing Address - Phone:917-744-9790
Mailing Address - Fax:
Practice Address - Street 1:14754 76TH RD
Practice Address - Street 2:MAILBOX 2 , 2ND FLOOR
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3140
Practice Address - Country:US
Practice Address - Phone:917-744-9790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV008522-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist