Active NPI
Djurabek Ismatov
- Health Educator
- Brooklyn, NY
National Provider Identifier
1295334480
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health Educator
- License
- LA1457148
- Practice address
- 1122 Coney Island Ave Ste a
Brooklyn, NY 11230-2345 - Phone
- (833) 743-0100
- Fax
- (718) 744-9774
- NPI assigned
- Oct 20, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | LA1457148 | NY | |
| Health Educator | 174H00000X | LA1457148 | NY | Primary |
Addresses
Primary practice location
1122 Coney Island Ave Ste a
Brooklyn, NY 11230-2345
Mailing address
1940 Ocean Ave Apt 6J
Brooklyn, NY 11230-6729
Phone (984) 377-3777
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LA1457148 | NY | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1603152000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603152000000",
"number": "1295334480",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1940 OCEAN AVE APT 6J",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112306729",
"telephone_number": "984-377-3777",
"fax_number": "718-744-9774"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1122 CONEY ISLAND AVE STE A",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112302345",
"telephone_number": "833-743-0100",
"fax_number": "718-744-9774"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ISMATOV",
"first_name": "DJURABEK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-10-20",
"last_updated": "2020-10-20",
"certification_date": "2020-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "NY",
"license": "LA1457148",
"primary": false
},
{
"code": "174H00000X",
"taxonomy_group": "",
"desc": "Health Educator",
"state": "NY",
"license": "LA1457148",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.