Healthcare Provider Details

I. General information

NPI: 1144360124
Provider Name (Legal Business Name): FLUSHING ORTHOPEDICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13421 MAPLE AVE
FLUSHING NY
11355-4527
US

IV. Provider business mailing address

13421 MAPLE AVE
FLUSHING NY
11355-4527
US

V. Phone/Fax

Practice location:
  • Phone: 718-939-7070
  • Fax:
Mailing address:
  • Phone: 718-939-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number239365-1
License Number StateNY

VIII. Authorized Official

Name: MAXIM TYORKIN
Title or Position: SUPERVISING PHYSICIAN
Credential: MD
Phone: 718-939-7070