Provider Demographics
NPI:1700232857
Name:LOLA ISKHAKOVA PHYSICIAN PLLC
Entity Type:Organization
Organization Name:LOLA ISKHAKOVA PHYSICIAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:LOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ISKHAKOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-420-3353
Mailing Address - Street 1:6520 BOOTH ST
Mailing Address - Street 2:# 3B
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4084
Mailing Address - Country:US
Mailing Address - Phone:347-420-3353
Mailing Address - Fax:718-236-1055
Practice Address - Street 1:9916 97TH ST
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-2509
Practice Address - Country:US
Practice Address - Phone:347-420-3353
Practice Address - Fax:718-236-1055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-08
Last Update Date:2016-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
273766OtherMEDICAL LICENSE