Provider Demographics
NPI:1053925750
Name:SALIEV, KURUSH (LMT)
Entity type:Individual
Prefix:
First Name:KURUSH
Middle Name:
Last Name:SALIEV
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2838 STILLWELL AVE APT 3A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-2685
Mailing Address - Country:US
Mailing Address - Phone:347-517-6518
Mailing Address - Fax:
Practice Address - Street 1:2838 STILLWELL AVE APT 3A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-2685
Practice Address - Country:US
Practice Address - Phone:347-517-6518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030671-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY030671-1OtherLICENSE