Provider Demographics
NPI:1396006193
Name:IBRAGIMOVA, BERTA (MS SPED)
Entity Type:Individual
Prefix:MRS
First Name:BERTA
Middle Name:
Last Name:IBRAGIMOVA
Suffix:
Gender:F
Credentials:MS SPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13767 70TH RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1929
Mailing Address - Country:US
Mailing Address - Phone:718-427-4613
Mailing Address - Fax:
Practice Address - Street 1:13767 70TH RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1929
Practice Address - Country:US
Practice Address - Phone:718-427-4613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1260523174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist