Healthcare Provider Details

I. General information

NPI: 1225579527
Provider Name (Legal Business Name): ALEX RAKHMINOV FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ALEX RAKHMINOV NP

II. Dates (important events)

Enumeration Date: 03/20/2017
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6433 98TH ST APT 5D
REGO PARK NY
11374-3304
US

IV. Provider business mailing address

6433 98TH ST APT 5D
REGO PARK NY
11374-3304
US

V. Phone/Fax

Practice location:
  • Phone: 646-919-1871
  • Fax: 575-209-2717
Mailing address:
  • Phone: 646-919-1871
  • Fax: 575-209-2717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number344761-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number696767
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: