Provider Demographics
NPI:1184242786
Name:MASHKABOV, ELIZABETH (MASTERS)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MASHKABOV
Suffix:
Gender:F
Credentials:MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6435 YELLOWSTONE BLVD APT 1J
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1725
Mailing Address - Country:US
Mailing Address - Phone:917-403-9633
Mailing Address - Fax:
Practice Address - Street 1:11506 ROCKAWAY BEACH BLVD
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11694-2346
Practice Address - Country:US
Practice Address - Phone:718-554-7766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator