Healthcare Provider Details

I. General information

NPI: 1790775070
Provider Name (Legal Business Name): YEVGENIYA KARMAZIN MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3084 BRIGHTON 13TH ST
BROOKLYN NY
11235-5608
US

IV. Provider business mailing address

2 BIRCH DR
HEWLETT NY
11557-2615
US

V. Phone/Fax

Practice location:
  • Phone: 718-891-5100
  • Fax: 718-891-8810
Mailing address:
  • Phone: 516-374-0974
  • Fax: 516-374-0978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number198112
License Number StateNY

VIII. Authorized Official

Name: YEVGENIYA KARMAZIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-891-5100