MEDICARE: AVI SHIMON MUSOEV FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	359852	NY

General Provider Information

NPI Number	:	1619809142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVI SHIMON MUSOEV FNP

Provider Business Mailing Address
First Line	:	962 PENINSULA BLVD
Second Line	:
City	:	WOODMERE
State	:	NY
Zip	:	11598-1542
Country	:	US
Telephone Number	:	917-525-7764
Fax Number	:

Provider Business Practice Location Address
First Line	:	962 PENINSULA BLVD
Second Line	:
City	:	WOODMERE
State	:	NY
Zip	:	11598-1542
Country	:	US
Telephone Number	:	917-525-7764
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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