Provider Demographics
NPI:1245016773
Name:ABAYEV, ELIZABETH (MSED)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:ABAYEV
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15020 78TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3437
Mailing Address - Country:US
Mailing Address - Phone:347-755-0605
Mailing Address - Fax:
Practice Address - Street 1:15020 78TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3437
Practice Address - Country:US
Practice Address - Phone:347-755-0605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
252Y00000X
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency