Healthcare Provider Details

I. General information

NPI: 1568171924
Provider Name (Legal Business Name): GULNARA KUDAIBERGENOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2022
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6106 23RD AVE APT 2F
BROOKLYN NY
11204-2617
US

IV. Provider business mailing address

6106 23RD AVE APT 2F
BROOKLYN NY
11204-2617
US

V. Phone/Fax

Practice location:
  • Phone: 917-615-7642
  • Fax:
Mailing address:
  • Phone: 917-615-7642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberCERTIFIED
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: