Provider Demographics
NPI:1265877070
Name:IFRAIMOVA, LIANA (LIANA IFRAIMOVA)
Entity type:Individual
Prefix:
First Name:LIANA
Middle Name:
Last Name:IFRAIMOVA
Suffix:
Gender:F
Credentials:LIANA IFRAIMOVA
Other - Prefix:
Other - First Name:LIANA
Other - Middle Name:
Other - Last Name:IFRAIMOVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EARLY CHILDHOOD
Mailing Address - Street 1:820 OCEAN PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-2186
Mailing Address - Country:US
Mailing Address - Phone:646-683-1207
Mailing Address - Fax:
Practice Address - Street 1:3711 35TH AVE STE 3C&3G
Practice Address - Street 2:SUITES 3C & 3G
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11101-1524
Practice Address - Country:US
Practice Address - Phone:646-683-1207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY614645121174400000X
NY614644121174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist