Provider Demographics
NPI:1174031645
Name:ABDURAKHMANOV, ELEONORA (MSED)
Entity Type:Individual
Prefix:
First Name:ELEONORA
Middle Name:
Last Name:ABDURAKHMANOV
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14711 JEWEL AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1712
Mailing Address - Country:US
Mailing Address - Phone:212-365-0184
Mailing Address - Fax:718-487-3805
Practice Address - Street 1:14711 JEWEL AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1712
Practice Address - Country:US
Practice Address - Phone:212-365-0184
Practice Address - Fax:718-487-3805
Is Sole Proprietor?:No
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1384686174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist