1235185778 NPI number — DR. ALEXANDER EUGENE ISTOMIN MD MD, MS, MS

Table of content: DR. ALEXANDER EUGENE ISTOMIN MD MD, MS, MS (NPI 1235185778)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235185778 NPI number — DR. ALEXANDER EUGENE ISTOMIN MD MD, MS, MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ISTOMIN MD
Provider First Name:
ALEXANDER
Provider Middle Name:
EUGENE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, MS, MS
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:
1235185778
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 95
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLD WESTBURY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11568-0095
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-554-7434
Provider Business Mailing Address Fax Number:
718-554-1666

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8708 JUSTICE AVE
Provider Second Line Business Practice Location Address:
SUITE 2E
Provider Business Practice Location Address City Name:
ELMHURST
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11373-4575
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-554-7434
Provider Business Practice Location Address Fax Number:
718-554-1666
Provider Enumeration Date:
05/26/2006

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: 363L00000X , with the licence number:  ARNP 9238727 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: F304254 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 242862 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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