Provider Demographics
NPI:1730512609
Name:POPOV, NIKOLAY
Entity type:Individual
Prefix:
First Name:NIKOLAY
Middle Name:
Last Name:POPOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2879 W 12TH ST APT 9Q
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-3026
Mailing Address - Country:US
Mailing Address - Phone:843-457-2795
Mailing Address - Fax:
Practice Address - Street 1:2879 W 12TH ST APT 9Q
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-3026
Practice Address - Country:US
Practice Address - Phone:843-457-2795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNONE OF ONE171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA205-897-896OtherPOLITICAL ASYLIM