Provider Demographics
NPI:1295046449
Name:IZYAYEVA, LYUBOV (NP)
Entity type:Individual
Prefix:
First Name:LYUBOV
Middle Name:
Last Name:IZYAYEVA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2195 E 22ND ST
Mailing Address - Street 2:#1C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3602
Mailing Address - Country:US
Mailing Address - Phone:718-648-4545
Mailing Address - Fax:718-648-7788
Practice Address - Street 1:2195 E 22ND ST
Practice Address - Street 2:#1C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3602
Practice Address - Country:US
Practice Address - Phone:718-648-4545
Practice Address - Fax:718-648-7788
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF305307-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health