Basic Information
| Provider Information | |||||||||
| NPI: | 1538619234 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | GAIDAMAK | ||||||||
| FirstName: | INNA | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8602 FOREST PKWY | ||||||||
| Address2: | APT 1-B | ||||||||
| City: | WOODHAVEN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114211125 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 55 BROAD ST | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100042501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183910611 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2016 | ||||||||
| LastUpdateDate: | 10/06/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 7272827 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.