Healthcare Provider Details

I. General information

NPI: 1619144516
Provider Name (Legal Business Name): NAILA RAIZ MAMMADOVA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2008
Last Update Date: 06/24/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 1ST AVE
NEW YORK NY
10016-6402
US

IV. Provider business mailing address

201 50TH AVE # 2G
LONG ISLAND CITY NY
11101-5824
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-7300
  • Fax:
Mailing address:
  • Phone: 646-824-8332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number10752167-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number274410
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: