Provider Demographics
NPI:1073253951
Name:KHALIZOVA, DILFUZA
Entity Type:Individual
Prefix:
First Name:DILFUZA
Middle Name:
Last Name:KHALIZOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 ABINGDON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-1313
Mailing Address - Country:US
Mailing Address - Phone:631-568-2616
Mailing Address - Fax:
Practice Address - Street 1:111 ABINGDON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-1313
Practice Address - Country:US
Practice Address - Phone:631-568-2616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY827020163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse