Provider Demographics
NPI:1730527599
Name:MASHKABOV, LYUDMILA
Entity type:Individual
Prefix:
First Name:LYUDMILA
Middle Name:
Last Name:MASHKABOV
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 1:6625 103RD ST
Mailing Address - Street 2:APT. 3X
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2001
Mailing Address - Country:US
Mailing Address - Phone:646-404-1258
Mailing Address - Fax:718-459-4045
Practice Address - Street 1:6625 103RD ST
Practice Address - Street 2:APT. 3X
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2001
Practice Address - Country:US
Practice Address - Phone:646-404-1258
Practice Address - Fax:718-459-4045
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY391260101174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY391260101OtherBOARD OF EDUCATION