Provider Demographics
NPI:1003160540
Name:GADIYEVA, ALLA (NURSE)
Entity Type:Individual
Prefix:MS
First Name:ALLA
Middle Name:
Last Name:GADIYEVA
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 OCEAN PKWY
Mailing Address - Street 2:APT 4C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-3258
Mailing Address - Country:US
Mailing Address - Phone:347-787-1904
Mailing Address - Fax:718-622-2558
Practice Address - Street 1:500 WEST 57TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:212-293-3000
Practice Address - Fax:212-292-8038
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY655466-1261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder