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General NPI Number Information
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NPI Number | 1902304520
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Entity Type | Individual
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Provider Name | AZAMAT MAIKOTOV RN
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Gender | Male
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Dates
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Enumeration Date | 01/29/2018
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 2601 OCEAN PKWY
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City | BROOKLYN
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State | NY
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Zip | 11235-7745
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Country | US
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Telephone | 844-692-4692
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 600
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City | LAWRENCE
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State | NY
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Zip | 11559-0600
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Country | US
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Telephone | 347-421-6788
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 26NR17531800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 627853
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 163WR0006X
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Taxonomy Name | Registered Nurse First Assistant
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License Number | 121625
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 121625
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License Number State | NY
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