Healthcare Provider Details

I. General information

NPI: 1912491556
Provider Name (Legal Business Name): GRIGORIY MASHKEVICH MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 PARK AVE
NEW YORK NY
10028-0210
US

IV. Provider business mailing address

PO BOX 2625
NEW YORK NY
10009-8925
US

V. Phone/Fax

Practice location:
  • Phone: 212-737-8700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: EMILY LAM
Title or Position: BILLING
Credential:
Phone: 914-222-0828