Provider Demographics
NPI:1326386426
Name:MURATOV, LARISA (MSED)
Entity type:Individual
Prefix:MS
First Name:LARISA
Middle Name:
Last Name:MURATOV
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:MS
Other - First Name:LARISA
Other - Middle Name:
Other - Last Name:SHALOMOV
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSED
Mailing Address - Street 1:253 W 35TH ST FL 16
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-1907
Mailing Address - Country:US
Mailing Address - Phone:718-728-8476
Mailing Address - Fax:718-746-7544
Practice Address - Street 1:24537 60TH AVE
Practice Address - Street 2:
Practice Address - City:DOUGLASTON
Practice Address - State:NY
Practice Address - Zip Code:11362-2014
Practice Address - Country:US
Practice Address - Phone:718-728-8476
Practice Address - Fax:718-746-7544
Is Sole Proprietor?:No
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY477804174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist