Provider Demographics
NPI:1619106234
Name:MASHAYEV, RUBEN (OTR/L)
Entity Type:Individual
Prefix:
First Name:RUBEN
Middle Name:
Last Name:MASHAYEV
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2327 83RD ST
Mailing Address - Street 2:STE A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-2750
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2327 83RD ST
Practice Address - Street 2:STE A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-2750
Practice Address - Country:US
Practice Address - Phone:718-513-4577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015253174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist