Healthcare Provider Details

I. General information

NPI: 1588956858
Provider Name (Legal Business Name): MIKHAL PLISHTIYEVA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2011
Last Update Date: 05/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W 57TH ST
NEW YORK NY
10019-2902
US

IV. Provider business mailing address

14743 78 RD
FLUSHING NY
11367-3535
US

V. Phone/Fax

Practice location:
  • Phone: 212-293-3000
  • Fax:
Mailing address:
  • Phone: 917-658-9943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number515240
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: