Provider Demographics
NPI:1407510456
Name:ERNAZAROVA, RANO
Entity Type:Individual
Prefix:
First Name:RANO
Middle Name:
Last Name:ERNAZAROVA
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 1:2939 AVENUE Y APT 4G
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1629
Mailing Address - Country:US
Mailing Address - Phone:717-675-3831
Mailing Address - Fax:
Practice Address - Street 1:2939 AVENUE Y APT 4G
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-1629
Practice Address - Country:US
Practice Address - Phone:717-675-3831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator