1700079621 NPI number — DR. ARTUR ALBERTOVICH MUSHYAKOV MD

Table of content: DR. ARTUR ALBERTOVICH MUSHYAKOV MD (NPI 1700079621)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700079621 NPI number — DR. ARTUR ALBERTOVICH MUSHYAKOV MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUSHYAKOV
Provider First Name:
ARTUR
Provider Middle Name:
ALBERTOVICH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700079621
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
97-11 HORACE HARDING EXPY
Provider Second Line Business Mailing Address:
APT 12 J
Provider Business Mailing Address City Name:
CORONA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11368-4758
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-760-1723
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
97-11 HORACE HARDING
Provider Second Line Business Practice Location Address:
APT 12 J
Provider Business Practice Location Address City Name:
CORONA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11368
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-309-1628
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  24510101 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 24510101 . This is a "LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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