Healthcare Provider Details

I. General information

NPI: 1942529367
Provider Name (Legal Business Name): EMIL L GURSHUMOV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 08/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3049 BRIGHTON 6TH ST UNIT CU 1
BROOKLYN NY
11235-3020
US

IV. Provider business mailing address

3049 BRIGHTON 6TH ST UNIT CU 1
BROOKLYN NY
11235-3020
US

V. Phone/Fax

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

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
# 2
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number25MA08762100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: