Provider Demographics
NPI:1598425043
Name:BABAISAKOVA, BERTA
Entity Type:Individual
Prefix:
First Name:BERTA
Middle Name:
Last Name:BABAISAKOVA
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 1:6336 99TH ST APT 7D
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1990
Mailing Address - Country:US
Mailing Address - Phone:347-372-9743
Mailing Address - Fax:
Practice Address - Street 1:1651 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5849
Practice Address - Country:US
Practice Address - Phone:718-998-1415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-26
Last Update Date:2021-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency