1255309761 NPI number — DR. NADEZHDA SHAGUMOVA M.D.

Table of content: DR. NADEZHDA SHAGUMOVA M.D. (NPI 1255309761)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255309761 NPI number — DR. NADEZHDA SHAGUMOVA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAGUMOVA
Provider First Name:
NADEZHDA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1255309761
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2829 OCEAN PARKWAY
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-616-0050
Provider Business Mailing Address Fax Number:
718-616-0065

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2829 OCEAN PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11235-7858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-616-0050
Provider Business Practice Location Address Fax Number:
718-616-0065
Provider Enumeration Date:
03/09/2006

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: 207RR0500X , with the licence number:  207429 , 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: 1839765 . This is a "FIRST HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 207429 . This is a "HEALTH FIRST" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7683488004 . This is a "CIGNA (INTERNAL MED)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7880054 . This is a "AETNA PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00001956778004 . This is a "UNITEDHEATHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7683488002 . This is a "CIGNA (RHEUMATOLOGY)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 318180301 . This is a "HEALTH PLUS (INTERNAL MED" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 56N491 . This is a "BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1000015266 . This is a "AFFINITY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2355619 . This is a "AETNA HMO (INTERNAL MED)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P2040069 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 318150501 . This is a "HEALTH PLUS (RHEUMATOLOGY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2359536 . This is a "AETNA HMO (RHEUMATOLOGY)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01925846 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1700138 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 207429 . This is a "HORIZON HEALTH CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 207429 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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