MEDICARE: INDZHYFE UMEROVA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	854234-01	NY

General Provider Information

NPI Number	:	1205533411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INDZHYFE UMEROVA

Provider Business Mailing Address
First Line	:	10236 64TH AVE APT 4D
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-1503
Country	:	US
Telephone Number	:	516-853-9938
Fax Number	:

Provider Business Practice Location Address
First Line	:	10236 64TH AVE APT 4D
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-1503
Country	:	US
Telephone Number	:	516-853-9938
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2023
Last Update Date	:	02/08/2023

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