Provider Demographics
NPI:1902200751
Name:NIYAZOV, ALEKSANDR
Entity Type:Individual
Prefix:MR
First Name:ALEKSANDR
Middle Name:
Last Name:NIYAZOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8310 118TH ST
Mailing Address - Street 2:APT# 5D
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-2375
Mailing Address - Country:US
Mailing Address - Phone:646-472-6550
Mailing Address - Fax:
Practice Address - Street 1:8310 118TH ST
Practice Address - Street 2:APT# 5D
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-2375
Practice Address - Country:US
Practice Address - Phone:646-472-6550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3608672390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program