Healthcare Provider Details

I. General information

NPI: 1063845154
Provider Name (Legal Business Name): GAMID ALIYEV FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 05/23/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 33RD ST STE 306
LONG ISLAND CITY NY
11106-2329
US

IV. Provider business mailing address

3636 33RD ST STE 306
LONG ISLAND CITY NY
11106-2329
US

V. Phone/Fax

Practice location:
  • Phone: 844-644-4325
  • Fax:
Mailing address:
  • Phone: 844-644-4325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number345573
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number008538
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF345573-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: