Provider Demographics
NPI:1588446058
Name:KUSKULOV, AZAMAT
Entity type:Individual
Prefix:
First Name:AZAMAT
Middle Name:
Last Name:KUSKULOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 CLAREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-4003
Mailing Address - Country:US
Mailing Address - Phone:332-733-9883
Mailing Address - Fax:
Practice Address - Street 1:155 CLAREMONT AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4003
Practice Address - Country:US
Practice Address - Phone:332-733-9883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)