MEDICARE: BAKHRIYA AGAYEVA

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	246XS1301X	Sonography Specialist/Technologist Cardiovascular

General Provider Information

NPI Number	:	1821750423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BAKHRIYA AGAYEVA

Provider Business Mailing Address
First Line	:	414 59TH ST APT 2
Second Line	:
City	:	WEST NEW YORK
State	:	NJ
Zip	:	07093-1172
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	414 59TH ST APT 2
Second Line	:
City	:	WEST NEW YORK
State	:	NJ
Zip	:	07093-1172
Country	:	US
Telephone Number	:	201-523-4807
Fax Number	:

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

Provider Enumeration Date	:	10/11/2021
Last Update Date	:	10/11/2021

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