Provider Demographics
NPI:1104180033
Name:NASIMOVA, ADELIYA (MS ED)
Entity Type:Individual
Prefix:
First Name:ADELIYA
Middle Name:
Last Name:NASIMOVA
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10310 QUEENS BLVD APT 4H
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3190
Mailing Address - Country:US
Mailing Address - Phone:718-809-2107
Mailing Address - Fax:
Practice Address - Street 1:10310 QUEENS BLVD APT 4H
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3190
Practice Address - Country:US
Practice Address - Phone:718-809-2107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2343916252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency