MEDICARE: NADYA IZIK RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	616704	NY

General Provider Information

NPI Number	:	1356785091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADYA IZIK RN

Provider Business Mailing Address
First Line	:	65-68 FITCHETT ST
Second Line	:
City	:	REGO PARK
State	:	NY
Zip	:	11374
Country	:	US
Telephone Number	:	718-897-5081
Fax Number	:

Provider Business Practice Location Address
First Line	:	6568 FITCHETT ST
Second Line	:
City	:	REGO PARK
State	:	NY
Zip	:	11374-5045
Country	:	US
Telephone Number	:	718-897-5081
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2013
Last Update Date	:	04/24/2013

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