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General NPI Number Information
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NPI Number | 1053063644
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Entity Type | Organization
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Legal Business Name | 5TH AVENUE WELLNESS MEDICINE PC
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Dates
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Enumeration Date | 01/25/2022
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Last Update Date | 01/26/2022
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Provider Practice Location Address
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Address Line | 1049 5TH AVE STE 1A
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City | NEW YORK
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State | NY
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Zip | 10028-0115
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Country | US
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Telephone | 718-989-9595
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Fax |
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Provider Business Mailing Address
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Address Line | 1049 5TH AVE STE 1A
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City | NEW YORK
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State | NY
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Zip | 10028-0115
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Country | US
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Telephone | 646-229-4926
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Fax |
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Authorized Official
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Title or Position | DO/OWNER
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Name | DR. MICHAEL NAYSHTUT
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Credential | DO
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Telephone | 718-989-9595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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