Provider Demographics
NPI:1770056970
Name:MUSAEV, RAKHAT (NP)
Entity type:Individual
Prefix:MRS
First Name:RAKHAT
Middle Name:
Last Name:MUSAEV
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:RAKHAT
Other - Middle Name:
Other - Last Name:KASIMOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:3636 WALDO AVE APT 3A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-2248
Mailing Address - Country:US
Mailing Address - Phone:347-330-7576
Mailing Address - Fax:
Practice Address - Street 1:1825 EASTCHESTER RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2301
Practice Address - Country:US
Practice Address - Phone:718-904-4105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF382884-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics