Healthcare Provider Details

I. General information

NPI: 1245563485
Provider Name (Legal Business Name): TIMUR MUSHEKOV PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2009
Last Update Date: 09/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E 233RD ST
BRONX NY
10466-2604
US

IV. Provider business mailing address

9211 101ST AVE APT 2F
OZONE PARK NY
11416-2319
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-9826
  • Fax:
Mailing address:
  • Phone: 917-628-7062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number006730-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number006730-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: