Healthcare Provider Details

I. General information

NPI: 1053063644
Provider Name (Legal Business Name): 5TH AVENUE WELLNESS MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10837 71ST AVE
FOREST HILLS NY
11375-4566
US

IV. Provider business mailing address

10837 71ST AVE
FOREST HILLS NY
11375-4566
US

V. Phone/Fax

Practice location:
  • Phone: 347-233-4988
  • Fax:
Mailing address:
  • Phone: 646-229-4926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL NAYSHTUT
Title or Position: DO/OWNER
Credential: DO
Phone: 347-233-4988