Provider Demographics
NPI:1437917366
Name:MUKHIDINOVA, MAMURA
Entity type:Individual
Prefix:
First Name:MAMURA
Middle Name:
Last Name:MUKHIDINOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4024 MANHATTAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-1008
Mailing Address - Country:US
Mailing Address - Phone:646-399-6665
Mailing Address - Fax:
Practice Address - Street 1:4024 MANHATTAN AVE FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-1008
Practice Address - Country:US
Practice Address - Phone:646-399-6665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator