Provider Demographics
NPI:1316352370
Name:NIYAZOV, GALINA (OD)
Entity type:Individual
Prefix:
First Name:GALINA
Middle Name:
Last Name:NIYAZOV
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 E 18TH ST APT 4E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-5330
Mailing Address - Country:US
Mailing Address - Phone:718-431-3945
Mailing Address - Fax:
Practice Address - Street 1:6373 108TH ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1607
Practice Address - Country:US
Practice Address - Phone:718-896-2020
Practice Address - Fax:718-459-3490
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV008170152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist