Provider Demographics
NPI:1538996145
Name:BARANOVA, DINA
Entity type:Individual
Prefix:
First Name:DINA
Middle Name:
Last Name:BARANOVA
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 1:67 MCLAUGHLIN ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4214
Mailing Address - Country:US
Mailing Address - Phone:646-236-6902
Mailing Address - Fax:
Practice Address - Street 1:67 MCLAUGHLIN ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-4214
Practice Address - Country:US
Practice Address - Phone:646-236-6902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist