Provider Demographics
NPI:1235997099
Name:BATUROV, ANZHELIKA
Entity Type:Individual
Prefix:
First Name:ANZHELIKA
Middle Name:
Last Name:BATUROV
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 1:11506 ROCKAWAY BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11694-2346
Mailing Address - Country:US
Mailing Address - Phone:718-554-7766
Mailing Address - Fax:
Practice Address - Street 1:21504 86TH AVE
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-1422
Practice Address - Country:US
Practice Address - Phone:347-842-9121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3094961174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist