Healthcare Provider Details

I. General information

NPI: 1295046449
Provider Name (Legal Business Name): LYUBOV IZYAYEVA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 06/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2195 E 22ND ST #1C
BROOKLYN NY
11229-3602
US

IV. Provider business mailing address

2195 E 22ND ST #1C
BROOKLYN NY
11229-3602
US

V. Phone/Fax

Practice location:
  • Phone: 718-648-4545
  • Fax: 718-648-7788
Mailing address:
  • Phone: 718-648-4545
  • Fax: 718-648-7788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF305307-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: