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General NPI Number Information
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NPI Number | 1285071555
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Entity Type | Individual
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Provider Name | VYACHESLAV GULKAROV FNP
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Gender | Male
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Dates
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Enumeration Date | 05/28/2013
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Last Update Date | 02/19/2020
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Provider Practice Location 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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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 |
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Name |
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Credential |
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Telephone |
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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 | 344086
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 624171-1
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License Number State | NY
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