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General NPI Number Information
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NPI Number | 1114994134
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Entity Type | Individual
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Provider Name | LUIZA GUSEYNOV M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/08/2006
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Last Update Date | 04/30/2012
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Provider Practice Location Address
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Address Line | 3108 KINGSBRIDGE AVE OFFICE B
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City | BRONX
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State | NY
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Zip | 10463-3956
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Country | US
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Telephone | 718-432-0200
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Fax |
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Provider Business Mailing Address
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Address Line | 168-32 POWELLS COVE BLVD
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City | BEECHHURST
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State | NY
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Zip | 11357-1523
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Country | US
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Telephone | 917-841-4129
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 233370
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License Number State | NY
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