=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578832267
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW YORK ADVANCED LAPAROSCOPIC AND BARIATRIC SURGERY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/24/2011
-----------------------------------------------------
Last Update Date | 10/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 150 BRIGHTON 11TH ST
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11235-5327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-616-1622
-----------------------------------------------------
Fax | 347-587-6861
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 BEEKMAN ST APT 12E
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10038-1810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SERGEY TERUSHKIN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 718-616-1622
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 262892
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------