Provider Demographics
NPI:1588928204
Name:KACHALOVA, ALLA (MD SP ED)
Entity type:Individual
Prefix:
First Name:ALLA
Middle Name:
Last Name:KACHALOVA
Suffix:
Gender:F
Credentials:MD SP ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 NOSTRAND AVE
Mailing Address - Street 2:APT 6H
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3757
Mailing Address - Country:US
Mailing Address - Phone:347-423-4687
Mailing Address - Fax:
Practice Address - Street 1:3315 NOSTRAND AVE
Practice Address - Street 2:APT 6H
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3757
Practice Address - Country:US
Practice Address - Phone:347-423-4687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1637189174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY174400000XOtherTEACHER