1790003374 NPI number — SAVI MUSHIYEV MD PC

Table of content: (NPI 1790003374)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790003374 NPI number — SAVI MUSHIYEV MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAVI MUSHIYEV MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1790003374
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10250 62ND RD
Provider Second Line Business Mailing Address:
APT 3G
Provider Business Mailing Address City Name:
FOREST HILLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11375-1056
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-275-2224
Provider Business Mailing Address Fax Number:
631-366-0391

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6260 108TH ST
Provider Second Line Business Practice Location Address:
1J
Provider Business Practice Location Address City Name:
FOREST HILLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11375-1356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-275-2224
Provider Business Practice Location Address Fax Number:
631-366-0391
Provider Enumeration Date:
05/06/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MURRAY
Authorized Official First Name:
MAUREEN
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING REP
Authorized Official Telephone Number:
631-366-0390

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  240021 , 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: 03162338 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: A400018611 . This is a "MEDICARE PTAN INDIVIDUAL" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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