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General NPI Number Information
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NPI Number | 1689873085
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Entity Type | Organization
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Legal Business Name | ENGLINTON MEDICAL PC
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Dates
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Enumeration Date | 07/16/2007
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Last Update Date | 04/25/2008
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Provider Practice Location Address
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Address Line | 9525 JAMAICA AVE
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City | WOODHAVEN
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State | NY
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Zip | 11421-2268
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Country | US
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Telephone | 718-441-4458
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Fax |
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Provider Business Mailing Address
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Address Line | 9525 JAMAICA AVE
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City | WOODHAVEN
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State | NY
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Zip | 11421-2268
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Country | US
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Telephone | 718-441-4458
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ARKADIY SHUSTERMAN
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Credential | MD
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Telephone | 718-441-4458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 217079
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License Number State | NY
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