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General NPI Number Information
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NPI Number | 1093960676
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Entity Type | Organization
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Legal Business Name | ADVANCED MULTICARE MEDICAL PC
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Dates
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Enumeration Date | 11/24/2008
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Last Update Date | 11/24/2008
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Provider Practice Location Address
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Address Line | 25 VICTORY BLVD 2ND FLOOR
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City | STATEN ISLAND
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State | NY
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Zip | 10301-2905
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Country | US
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Telephone | 718-815-7246
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Fax | 516-706-1085
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Provider Business Mailing Address
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Address Line | 25 VICTORY BLVD 2ND FLOOR
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City | STATEN ISLAND
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State | NY
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Zip | 10301-2905
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Country | US
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Telephone | 718-815-7246
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Fax | 516-706-1085
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. MIKHAIL J ARTAMONOV
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Credential | MD
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Telephone | 718-815-7246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 250059
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 250059
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License Number State | NY
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