Healthcare Provider Details

I. General information

NPI: 1679478929
Provider Name (Legal Business Name): YAIR MIRZAKANDOV
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14437 75TH RD FL 3
FLUSHING NY
11367-2416
US

IV. Provider business mailing address

14437 75TH RD FL 3
FLUSHING NY
11367-2416
US

V. Phone/Fax

Practice location:
  • Phone: 347-606-0751
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number031509
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: