Provider Demographics
NPI:1497573760
Name:AVENUE S NP IN FAMILY HEALTH PC
Entity type:Organization
Organization Name:AVENUE S NP IN FAMILY HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAHZODA
Authorized Official - Middle Name:
Authorized Official - Last Name:YULDASHEVA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:347-651-9939
Mailing Address - Street 1:1000 RIVERTON ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-2256
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3364 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4004
Practice Address - Country:US
Practice Address - Phone:347-651-9939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty