Provider Demographics
NPI:1982136628
Name:ABDIEVA, BAKTYGUL
Entity Type:Individual
Prefix:
First Name:BAKTYGUL
Middle Name:
Last Name:ABDIEVA
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 1:23A DOTY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4717
Mailing Address - Country:US
Mailing Address - Phone:347-449-2307
Mailing Address - Fax:
Practice Address - Street 1:23A DOTY AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-4717
Practice Address - Country:US
Practice Address - Phone:347-449-2307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY683483163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0400XNursing Service ProvidersRegistered NurseRehabilitation