Healthcare Provider Details

I. General information

NPI: 1679574941
Provider Name (Legal Business Name): RENAT ARSLANOV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 01/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 VAN CORTLANDT PARK E
BRONX NY
10470-1875
US

IV. Provider business mailing address

22 SAW MILL RIVER RD
HAWTHORNE NY
10532-1533
US

V. Phone/Fax

Practice location:
  • Phone: 718-231-6565
  • Fax: 718-231-8477
Mailing address:
  • Phone: 914-593-1606
  • Fax: 914-593-1790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberP6775
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberP6775
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number246229
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: