Healthcare Provider Details

I. General information

NPI: 1962132225
Provider Name (Legal Business Name): ARTEM YURYEV RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 YORK AVE
NEW YORK NY
10065-6007
US

IV. Provider business mailing address

179 BENNETT AVE APT 8C
NEW YORK NY
10040-4059
US

V. Phone/Fax

Practice location:
  • Phone: 212-639-2323
  • Fax:
Mailing address:
  • Phone: 917-548-5386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number723104
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number723104
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number154931
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: