Healthcare Provider Details

I. General information

NPI: 1932531340
Provider Name (Legal Business Name): EMIL GURSHUMOV MEDICAL P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2013
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2265 OCEAN PKWY APT 2B
BROOKLYN NY
11223-5149
US

IV. Provider business mailing address

1811 QUENTIN RD APT 2D
BROOKLYN NY
11229-1343
US

V. Phone/Fax

Practice location:
  • Phone: 718-934-0322
  • Fax: 718-934-0994
Mailing address:
  • Phone: 646-633-3833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number265211
License Number StateNY

VIII. Authorized Official

Name: DR. EMIL L GURSHUMOV
Title or Position: PRESIDENT AND OWNER
Credential: MD
Phone: 718-934-0322