Provider Demographics
NPI:1740804442
Name:HAKIMIAN, ALIZA
Entity Type:Individual
Prefix:
First Name:ALIZA
Middle Name:
Last Name:HAKIMIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 HILL PARK AVE APT 2N
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3709
Mailing Address - Country:US
Mailing Address - Phone:516-829-5017
Mailing Address - Fax:
Practice Address - Street 1:15 HILL PARK AVE APT 2N
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-3709
Practice Address - Country:US
Practice Address - Phone:516-829-5017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303311208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice