Provider Demographics
NPI:1679626022
Name:IBRAGIMOVA, GALINA (MD, FAAP)
Entity Type:Individual
Prefix:DR
First Name:GALINA
Middle Name:
Last Name:IBRAGIMOVA
Suffix:
Gender:F
Credentials:MD, FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 HAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4107
Mailing Address - Country:US
Mailing Address - Phone:718-934-8964
Mailing Address - Fax:718-934-2260
Practice Address - Street 1:9876 QUEENS BLVD STE P3
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4356
Practice Address - Country:US
Practice Address - Phone:718-459-3000
Practice Address - Fax:718-459-5125
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2106332080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01878151Medicaid
NY7584Medicare UPIN