Provider Demographics
NPI:1679786750
Name:ALIBASIC, SULTANA (RN)
Entity type:Individual
Prefix:MRS
First Name:SULTANA
Middle Name:
Last Name:ALIBASIC
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3280 RESERVOIR OVAL EAST
Mailing Address - Street 2:APT. B4
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467
Mailing Address - Country:US
Mailing Address - Phone:718-515-0623
Mailing Address - Fax:
Practice Address - Street 1:3280 RESERVOIR OVAL EAST
Practice Address - Street 2:APT. B4
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-515-0623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251892164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse