MEDICARE: IGOR GUTNIK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	224819	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073684726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IGOR GUTNIK M.D.

Provider Business Mailing Address
First Line	:	2873 VALERIE CT
Second Line	:
City	:	MERRICK
State	:	NY
Zip	:	11566-4654
Country	:	US
Telephone Number	:	516-578-1489
Fax Number	:	516-992-0701

Provider Business Practice Location Address
First Line	:	49 OAKCREST AVE
Second Line	:
City	:	MIDDLE ISLAND
State	:	NY
Zip	:	11953-1415
Country	:	US
Telephone Number	:	516-578-1489
Fax Number	:	908-450-0280

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	09/25/2023

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