Doctor Name: | NIKOLAY KORNEYCHUK |
NPI Number: | 1770977613 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 337700 |
Business Practice Address: | 111 S Congress St York, SC - 297451836 |
Business Phone Number: | 8036840035 |
Business Fax Number: | |
Mailing Address: | 1780 Compton Bridge Rd, INMAN |
State: | SC |
Postal Code: | 293498482 |
Phone Number: | 8648044510 |
Fax Number: | |
NPI Enumeration Date: | 03/27/2015 |
NPI Last Update Date: | 03/27/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | 337700 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SC |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |