Healthcare Provider Details

I. General information

NPI: 1104349398
Provider Name (Legal Business Name): SERGIY SHURIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20606 HILLSIDE AVE
QUEENS VILLAGE NY
11427-1710
US

IV. Provider business mailing address

PO BOX 416173
BOSTON MA
02241-6173
US

V. Phone/Fax

Practice location:
  • Phone: 718-820-9729
  • Fax: 718-820-9730
Mailing address:
  • Phone: 610-644-8900
  • Fax: 484-924-0053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number307367
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number307367
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: