Healthcare Provider Details

I. General information

NPI: 1366856874
Provider Name (Legal Business Name): DANIEL KURBANOV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N VILLAGE AVE STE 300
ROCKVILLE CENTRE NY
11570-2300
US

IV. Provider business mailing address

200 N VILLAGE AVE STE 300
ROCKVILLE CENTRE NY
11570-2300
US

V. Phone/Fax

Practice location:
  • Phone: 516-536-8151
  • Fax:
Mailing address:
  • Phone: 516-536-8151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number61669
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number303509
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number303509
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: