Provider Demographics
NPI:1841741725
Name:DIZENGOF, NATALYA (RN, FNP)
Entity Type:Individual
Prefix:MS
First Name:NATALYA
Middle Name:
Last Name:DIZENGOF
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 BROAD ST
Mailing Address - Street 2:21ST FL.
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-2501
Mailing Address - Country:US
Mailing Address - Phone:708-628-7667
Mailing Address - Fax:
Practice Address - Street 1:55 BROAD ST
Practice Address - Street 2:21ST FL.
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-2501
Practice Address - Country:US
Practice Address - Phone:708-628-7667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-17
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY612141-1163WE0003X
NYF340393-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency