Provider Demographics
NPI:1053076281
Name:GANIEV, ULUGBEK (PT)
Entity Type:Individual
Prefix:
First Name:ULUGBEK
Middle Name:
Last Name:GANIEV
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3319 AVENUE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-2605
Mailing Address - Country:US
Mailing Address - Phone:718-258-3300
Mailing Address - Fax:718-258-3301
Practice Address - Street 1:3319 AVENUE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-2605
Practice Address - Country:US
Practice Address - Phone:718-258-3300
Practice Address - Fax:718-258-3301
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047995225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist