Provider Information for 1386371649
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ILONA BAKMAN
Sex: Female
NPI: 1386371649
Last Updated: 2022-08-05
Certification Date: 2022-07-29
Certification Date: 2022-07-29
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1386371649 | ||||||||
| Enumeration Date | 2022-08-05 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 21 TRAVIS AVE STATEN ISLAND, NY 10314-6209 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 10470 QUEENS BLVD STE 200 FOREST HILLS, NY 11375-3694 United States Phone: 917-478-0884 | Fax: | ||||||||
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