Healthcare Provider Details

I. General information

NPI: 1821216409
Provider Name (Legal Business Name): YEVGENY AZRIELI, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 AMSTERDAM AVE SUITE 5F
NEW YORK NY
10025-1737
US

IV. Provider business mailing address

1090 AMSTERDAM AVE SUITE 5F
NEW YORK NY
10025-1737
US

V. Phone/Fax

Practice location:
  • Phone: 212-523-3652
  • Fax: 212-523-2679
Mailing address:
  • Phone: 212-523-3652
  • Fax: 212-523-2679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number208980
License Number StateNY

VIII. Authorized Official

Name: DR. YEVGENY AZRIELI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 212-523-3652