Provider Demographics
NPI:1124905179
Name:DAVLETALINOV, NURLAN
Entity type:Individual
Prefix:
First Name:NURLAN
Middle Name:
Last Name:DAVLETALINOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4414 47TH AVE APT C2
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-6115
Mailing Address - Country:US
Mailing Address - Phone:516-800-6882
Mailing Address - Fax:
Practice Address - Street 1:4414 47TH AVE APT C2
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-6115
Practice Address - Country:US
Practice Address - Phone:516-800-6882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP137752207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine