Healthcare Provider Details

I. General information

NPI: 1306026596
Provider Name (Legal Business Name): ALEXEY MIGIROV MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 CORBIN AVE
STATEN ISLAND NY
10308-1877
US

IV. Provider business mailing address

7508 BAY PKWY
BROOKLYN NY
11214-1515
US

V. Phone/Fax

Practice location:
  • Phone: 718-372-9300
  • Fax: 718-837-0460
Mailing address:
  • Phone: 718-372-9300
  • Fax: 718-837-0460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number223268-1
License Number StateNY

VIII. Authorized Official

Name: MR. ALEXEY MIGIROV
Title or Position: MD
Credential:
Phone: 718-372-9300