Provider Demographics
NPI:1689339780
Name:FOURAZ-BOUCEKINE, MALIKA (RN)
Entity Type:Individual
Prefix:
First Name:MALIKA
Middle Name:
Last Name:FOURAZ-BOUCEKINE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3126 33RD STREET APT 3R
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-2421
Mailing Address - Country:US
Mailing Address - Phone:347-345-8701
Mailing Address - Fax:
Practice Address - Street 1:3126 33RD STREET APT 3R
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-2421
Practice Address - Country:US
Practice Address - Phone:347-345-8701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY813076-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse