Healthcare Provider Details

I. General information

NPI: 1336840750
Provider Name (Legal Business Name): MRS. YULIYA LIUBIMAVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 03/13/2023
Certification Date: 03/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2148 OCEAN AVE STE 302
BROOKLYN NY
11229-1484
US

IV. Provider business mailing address

110 NEPTUNE AVE APT 3B
BROOKLYN NY
11235-5377
US

V. Phone/Fax

Practice location:
  • Phone: 718-375-2505
  • Fax:
Mailing address:
  • Phone: 347-331-8428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: