Provider Demographics
NPI:1225579527
Name:RAKHMINOV, ALEX (FNP)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:RAKHMINOV
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:RAKHMINOV
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6433 98TH ST
Mailing Address - Street 2:APT5D
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3321
Mailing Address - Country:US
Mailing Address - Phone:646-919-1871
Mailing Address - Fax:
Practice Address - Street 1:6433 98TH ST
Practice Address - Street 2:APT5D
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3321
Practice Address - Country:US
Practice Address - Phone:646-919-1871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-20
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY696767163W00000X
NY344761-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty