Provider Demographics
NPI:1891918488
Name:AIVAZI, NANA (MD,)
Entity Type:Individual
Prefix:DR
First Name:NANA
Middle Name:
Last Name:AIVAZI
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:DR
Other - First Name:NANA
Other - Middle Name:
Other - Last Name:AYVAZASHVILI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6336 98TH PL
Mailing Address - Street 2:APT #3F
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2330
Mailing Address - Country:US
Mailing Address - Phone:646-209-8091
Mailing Address - Fax:
Practice Address - Street 1:6336 98TH PL
Practice Address - Street 2:APT #3F
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2330
Practice Address - Country:US
Practice Address - Phone:646-209-8091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238649207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine