Basic Information
Provider Information
NPI: 1063845154
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALIYEV
FirstName: GAMID
MiddleName:  
NamePrefix: MR.
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3636 33RD ST STE 306
Address2:  
City: LONG ISLAND CITY
State: NY
PostalCode: 111062329
CountryCode: US
TelephoneNumber: 8446444325
FaxNumber:  
Practice Location
Address1: 3636 33RD ST STE 306
Address2:  
City: LONG ISLAND CITY
State: NY
PostalCode: 111062329
CountryCode: US
TelephoneNumber: 8446444325
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/13/2013
LastUpdateDate: 05/23/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/23/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X345573NYY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
2279C0205X008538NYN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredCritical Care
363LF0000XF345573-01NYN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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