Provider Demographics
NPI:1568027787
Name:JURABOEV, AHATJON (MD, MPH)
Entity Type:Individual
Prefix:MR
First Name:AHATJON
Middle Name:
Last Name:JURABOEV
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 CLARKSON AVENUE, BOX 1213
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2098
Mailing Address - Country:US
Mailing Address - Phone:718-270-4232
Mailing Address - Fax:718-270-3840
Practice Address - Street 1:450 CLARKSON AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2098
Practice Address - Country:US
Practice Address - Phone:718-270-4232
Practice Address - Fax:718-270-3840
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2023-05-22
Deactivation Date:2019-12-16
Deactivation Code:
Reactivation Date:2021-07-09
Provider Licenses
StateLicense IDTaxonomies
390200000X
MEMD264222084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program