Healthcare Provider Details

I. General information

NPI: 1689925372
Provider Name (Legal Business Name): ADVANCED ORTHOPEDICS AND JOINT PRESERVATION PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2012
Last Update Date: 09/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 E MERRICK RD SUITE B
VALLEY STREAM NY
11580-5925
US

IV. Provider business mailing address

141 E MERRICK RD SUITE B
VALLEY STREAM NY
11580-5925
US

V. Phone/Fax

Practice location:
  • Phone: 516-887-5500
  • Fax: 516-887-5509
Mailing address:
  • Phone: 516-887-5500
  • Fax: 516-887-5509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number233630
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number233630
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number233630
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number233630
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number233630
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number233630
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number233630
License Number StateNY

VIII. Authorized Official

Name: DR. STANISLAV AVSHALUMOV
Title or Position: PRESIDENT
Credential: D.O., M.D.
Phone: 516-887-5500