Provider Demographics
NPI:1841546918
Name:NISIMOVA, NADEZHDA (OD)
Entity type:Individual
Prefix:DR
First Name:NADEZHDA
Middle Name:
Last Name:NISIMOVA
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 1:9119 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5531
Mailing Address - Country:US
Mailing Address - Phone:347-295-1605
Mailing Address - Fax:
Practice Address - Street 1:9119 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5531
Practice Address - Country:US
Practice Address - Phone:347-295-1605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007898152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist