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1114925765

NPI Code Detail

MEDICARE: YEVGENIY SHUSTOROVICH MD

MEDICARE: YEVGENIY SHUSTOROVICH MD

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	207L00000X	Anesthesiology Physician	213579-1	NY
2	207L00000X	Anesthesiology Physician	ME165853	FL

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	:	1114925765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YEVGENIY SHUSTOROVICH MD

Provider Business Mailing Address
First Line	:	PO BOX 5024
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10087-5024
Country	:	US
Telephone Number	:	800-627-4470
Fax Number	:	412-937-5710

Provider Business Practice Location Address
First Line	:	1 GUSTAVE L LEVY PL
Second Line	:	ANESTHESIOLOGY - BOX 1010
City	:	NEW YORK
State	:	NY
Zip	:	10029-6504
Country	:	US
Telephone Number	:	800-627-4470
Fax Number	:	412-937-5710

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

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	12/11/2024

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Directions to “ YEVGENIY SHUSTOROVICH MD” Practice Location

Language	Start Address	Practice Location

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