Provider Demographics
NPI:1588925481
Name:LOBANOVA, NATALIA (MSED)
Entity type:Individual
Prefix:MRS
First Name:NATALIA
Middle Name:
Last Name:LOBANOVA
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14911 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-1634
Mailing Address - Country:US
Mailing Address - Phone:917-318-1967
Mailing Address - Fax:718-445-0775
Practice Address - Street 1:14911 7TH AVE
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-1634
Practice Address - Country:US
Practice Address - Phone:917-318-1967
Practice Address - Fax:718-445-0775
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1708839174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist