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General NPI Number Information
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NPI Number | 1205469244
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Entity Type | Organization
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Legal Business Name | GULKAROV FAMILY HEALTH NP PLLC
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Dates
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Enumeration Date | 02/18/2020
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Last Update Date | 02/18/2020
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Provider Practice Location Address
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Address Line | 4047 95TH ST APT B
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City | ELMHURST
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State | NY
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Zip | 11373-1715
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Country | US
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Telephone | 646-559-6699
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Fax |
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Provider Business Mailing Address
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Address Line | 6560 BOOTH ST APT 4D
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City | REGO PARK
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State | NY
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Zip | 11374-4133
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Country | US
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Telephone | 917-640-4589
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | VYACHESLAV GULKAROV
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Credential |
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Telephone | 917-640-4589
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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