=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447688908
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALBINA ISKHAKOVA OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2013
-----------------------------------------------------
Last Update Date | 10/21/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4020 74TH ST
-----------------------------------------------------
City | ELMHURST
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11373-5602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-940-8758
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7516 VLEIGH PL
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11367-2841
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-940-8758
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Clinic/Center
-----------------------------------------------------
License Number | 018282
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------