Provider Demographics
NPI:1457670168
Name:SULEYMANOVA, NARGIZ
Entity Type:Individual
Prefix:MRS
First Name:NARGIZ
Middle Name:
Last Name:SULEYMANOVA
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 1:6601 BURNS ST APT 2C
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3901
Mailing Address - Country:US
Mailing Address - Phone:347-755-9595
Mailing Address - Fax:
Practice Address - Street 1:40 NATHANIEL PL
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2736
Practice Address - Country:US
Practice Address - Phone:201-816-8330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054225183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist