Provider Demographics
NPI:1316378128
Name:ISKHAKOV, ROBERT
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:ISKHAKOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 W 34TH ST
Mailing Address - Street 2:946
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10122-0049
Mailing Address - Country:US
Mailing Address - Phone:212-804-7659
Mailing Address - Fax:
Practice Address - Street 1:225 W 34TH ST
Practice Address - Street 2:946
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10122-0049
Practice Address - Country:US
Practice Address - Phone:212-804-7659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-04
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst