Provider Demographics
NPI:1538753975
Name:SABIROVA, GULNOZA
Entity type:Individual
Prefix:
First Name:GULNOZA
Middle Name:
Last Name:SABIROVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 WETHEROLE ST APT 6A
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4780
Mailing Address - Country:US
Mailing Address - Phone:347-720-2533
Mailing Address - Fax:
Practice Address - Street 1:6565 WETHEROLE ST APT 6A
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4780
Practice Address - Country:US
Practice Address - Phone:347-720-2533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY743485989-00Medicaid