Healthcare Provider Details

I. General information

NPI: 1558323675
Provider Name (Legal Business Name): ARKADIY BAUMVAL PA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 10TH AVE SUITE 5G-80
NEW YORK NY
10019-1147
US

IV. Provider business mailing address

197 BAY 47TH ST APT.#6
BROOKLYN NY
11214-6889
US

V. Phone/Fax

Practice location:
  • Phone: 212-523-6720
  • Fax:
Mailing address:
  • Phone: 718-759-6644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number006984
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: