Provider Demographics
NPI:1275642886
Name:NASIROV, SHIRLEY (DPT)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:
Last Name:NASIROV
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 COLUMBUS AVE
Mailing Address - Street 2:APT 5W
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:10025
Mailing Address - Country:US
Mailing Address - Phone:917-756-2706
Mailing Address - Fax:
Practice Address - Street 1:750 COLUMBUS AVE
Practice Address - Street 2:APT 5W
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6464
Practice Address - Country:US
Practice Address - Phone:917-756-2706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist