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General NPI Number Information
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NPI Number | 1669689808
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Entity Type | Organization
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Legal Business Name | HEALTHY LIFE MEDICAL PC
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1120 BRIGHTON BEACH AVE SUITE 6 0
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City | BROOKLYN
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State | NY
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Zip | 11235
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Country | US
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Telephone | 718-646-3750
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Fax | 718-646-3750
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Provider Business Mailing Address
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Address Line | 1120 BRIGHTON BEACH AVE SUITE 6 0
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City | BROOKLYN
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State | NY
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Zip | 11235
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Country | US
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Telephone | 718-646-3750
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Fax | 718-646-3877
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Authorized Official
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Title or Position | PRESIDENT
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Name | SEMEN AVSHALUMOV
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Credential | MD
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Telephone | 718-646-3750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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