Provider Demographics
NPI:1730316316
Name:MURATOV-SULEYMANOV, AKSANA
Entity Type:Individual
Prefix:MRS
First Name:AKSANA
Middle Name:
Last Name:MURATOV-SULEYMANOV
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:AKSANA
Other - Middle Name:
Other - Last Name:SULEYMANOV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:7502 169TH ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1338
Mailing Address - Country:US
Mailing Address - Phone:917-293-2661
Mailing Address - Fax:
Practice Address - Street 1:VA NY HARBOR HEALTHCARE SYSTEM
Practice Address - Street 2:423 E 23RD ST
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010
Practice Address - Country:US
Practice Address - Phone:212-686-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013236363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant