Provider Demographics
NPI:1548028467
Name:MIRZOKANDOVA, ESTER
Entity type:Individual
Prefix:
First Name:ESTER
Middle Name:
Last Name:MIRZOKANDOVA
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 1:6714 108TH ST APT 6G
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2190
Mailing Address - Country:US
Mailing Address - Phone:347-571-3212
Mailing Address - Fax:
Practice Address - Street 1:6519 BORDEN AVE
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-1630
Practice Address - Country:US
Practice Address - Phone:718-581-3212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF11230719363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily