Provider Demographics
NPI:1215823059
Name:BOKTAEVA, IANA
Entity type:Individual
Prefix:
First Name:IANA
Middle Name:
Last Name:BOKTAEVA
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 1:29 SUNNYSIDE TER APT 2
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-4035
Mailing Address - Country:US
Mailing Address - Phone:929-406-8513
Mailing Address - Fax:929-406-8513
Practice Address - Street 1:29 SUNNYSIDE TER APT 2
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-4035
Practice Address - Country:US
Practice Address - Phone:929-406-8513
Practice Address - Fax:929-406-8513
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator