Provider Demographics
NPI:1891382487
Name:NIYAZOV, RADION
Entity type:Individual
Prefix:
First Name:RADION
Middle Name:
Last Name:NIYAZOV
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 1:15640C CROSSBAY BLVD
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-2771
Mailing Address - Country:US
Mailing Address - Phone:718-406-7666
Mailing Address - Fax:
Practice Address - Street 1:15640C CROSSBAY BLVD
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-2771
Practice Address - Country:US
Practice Address - Phone:718-406-7666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNO FAULT
NAOtherNO FAULT/PRIVATE