Provider Demographics
NPI:1013253459
Name:ISAKOV, SVETLANA (PROFESSIONAL LICENSE)
Entity Type:Individual
Prefix:
First Name:SVETLANA
Middle Name:
Last Name:ISAKOV
Suffix:
Gender:F
Credentials:PROFESSIONAL LICENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14448 77TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3130
Mailing Address - Country:US
Mailing Address - Phone:347-901-1488
Mailing Address - Fax:
Practice Address - Street 1:14448 77TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3130
Practice Address - Country:US
Practice Address - Phone:347-901-1488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY567243111174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist