Provider Demographics
NPI:1255098679
Name:RUSTAMI, GULNOZA RUSTAMI
Entity type:Individual
Prefix:
First Name:GULNOZA
Middle Name:RUSTAMI
Last Name:RUSTAMI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHAHNOZ
Other - Middle Name:
Other - Last Name:RUSTAMOVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:280 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-1234
Mailing Address - Country:US
Mailing Address - Phone:321-263-9362
Mailing Address - Fax:201-205-2206
Practice Address - Street 1:83 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-2517
Practice Address - Country:US
Practice Address - Phone:551-998-8010
Practice Address - Fax:201-205-2206
Is Sole Proprietor?:No
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XR0403XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistDriving and Community Mobility