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General NPI Number Information
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NPI Number | 1851464853
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Entity Type | Individual
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Provider Name | ERIK P MORDUKHAYEV N.P.
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Gender | Male
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 1042 FLATBUSH AVE
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City | BROOKLYN
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State | NY
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Zip | 11226-5428
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Country | US
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Telephone | 718-635-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 6361 FITCHETT ST
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City | REGO PARK
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State | NY
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Zip | 11374-2811
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Country | US
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Telephone | 646-334-1324
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 303815
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | F303815
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License Number State | NY
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