1932370731 NPI number — DR. YURY TAKHALOV MD

Table of content: DR. YURY TAKHALOV MD (NPI 1932370731)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932370731 NPI number — DR. YURY TAKHALOV MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAKHALOV
Provider First Name:
YURY
Provider Middle Name:
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:
1932370731
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
840 S. WOOD ST., SUITE 130 CSN
Provider Second Line Business Mailing Address:
UNIVERSITY OF ILLINOIS AT CHICAGO
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-996-3879
Provider Business Mailing Address Fax Number:
312-413-1436

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
STONY BROOK UNIVERSITY HOSPITAL
Provider Second Line Business Practice Location Address:
DEPT OF PATHOLOGY HOS2
Provider Business Practice Location Address City Name:
STONY BROOK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11794-7025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-444-2224
Provider Business Practice Location Address Fax Number:
631-444-3424
Provider Enumeration Date:
03/19/2008

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: 207ZP0102X , with the licence number:  255706 , 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)





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