Provider Demographics
NPI:1295098192
Name:KARADIMOVA, TAISIYA (MSSPED)
Entity type:Individual
Prefix:
First Name:TAISIYA
Middle Name:
Last Name:KARADIMOVA
Suffix:
Gender:F
Credentials:MSSPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CO OP CITY BLVD APT 21F
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-3820
Mailing Address - Country:US
Mailing Address - Phone:646-344-0515
Mailing Address - Fax:718-379-0335
Practice Address - Street 1:120 CO OP CITY BLVD APT 21F
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-3820
Practice Address - Country:US
Practice Address - Phone:646-344-0515
Practice Address - Fax:718-379-0335
Is Sole Proprietor?:No
Enumeration Date:2012-06-17
Last Update Date:2012-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY699421174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist