Provider Demographics
NPI:1003219312
Name:KASAEV-CHANIMOV, COHAVA (CNM)
Entity type:Individual
Prefix:MS
First Name:COHAVA
Middle Name:
Last Name:KASAEV-CHANIMOV
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4166A WHITE PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-3020
Mailing Address - Country:US
Mailing Address - Phone:718-696-6262
Mailing Address - Fax:718-696-6260
Practice Address - Street 1:4166A WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-3020
Practice Address - Country:US
Practice Address - Phone:718-696-6262
Practice Address - Fax:718-696-6260
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-30
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001645367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty