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General NPI Number Information
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NPI Number | 1699099671
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Entity Type | Individual
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Provider Name | VITALY TERUSHKIN
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Gender | Male
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Dates
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Enumeration Date | 03/20/2010
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Last Update Date | 01/02/2022
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Provider Practice Location Address
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Address Line | 205 E 69TH ST APT 1C
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City | NEW YORK
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State | NY
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Zip | 10021-5437
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Country | US
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Telephone | 212-772-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 205 E 69TH ST APT 1C
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City | NEW YORK
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State | NY
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Zip | 10021-5437
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Country | US
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Telephone | 212-772-3600
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | MD451382
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 25MA09654300
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 269373
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 269373
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 25MA09654300
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License Number State | NJ
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