Provider Demographics
NPI:1932461977
Name:TIMOFEEV, ESMIRA (MS)
Entity Type:Individual
Prefix:MRS
First Name:ESMIRA
Middle Name:
Last Name:TIMOFEEV
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 DAHILL RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-3537
Mailing Address - Country:US
Mailing Address - Phone:718-375-2505
Mailing Address - Fax:718-375-2472
Practice Address - Street 1:1580 DAHILL RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-3537
Practice Address - Country:US
Practice Address - Phone:718-375-2505
Practice Address - Fax:718-375-2472
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1399794174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1399794OtherPUBLIC SCHOOL TEACHER CERTIFICATE