Provider Demographics
NPI:1780072819
Name:ALIBAYOF, ASHLEY
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:ALIBAYOF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 S MIDDLE NECK RD
Mailing Address - Street 2:APT 3H
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3446
Mailing Address - Country:US
Mailing Address - Phone:516-528-5937
Mailing Address - Fax:
Practice Address - Street 1:50 S MIDDLE NECK RD
Practice Address - Street 2:APT 3H
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-3446
Practice Address - Country:US
Practice Address - Phone:516-528-5937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-23
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY890171141174400000X
NY890049141174400000X
NY819176141174400000X
NY81917514174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist