Provider Demographics
NPI:1316313083
Name:BANGIEVA, MARIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:BANGIEVA
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:PO BOX 801280
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-1280
Mailing Address - Country:US
Mailing Address - Phone:718-576-4652
Mailing Address - Fax:
Practice Address - Street 1:10407 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6735
Practice Address - Country:US
Practice Address - Phone:718-576-4652
Practice Address - Fax:516-710-7846
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY662732163W00000X
NYF309703363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse