MEDICARE: YURIY PASISNICHENKO 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	207R00000X	Internal Medicine Physician	ME150604	FL
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	25MA13036900	NJ
3	208M00000X	Hospitalist Physician	ME150604	FL

General Provider Information

NPI Number	:	1174029540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YURIY PASISNICHENKO MD

Provider Business Mailing Address
First Line	:	3180 S OCEAN DR APT 1020
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-7251
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3180 S OCEAN DR APT 1020
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-7251
Country	:	US
Telephone Number	:	718-250-6604
Fax Number	:

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

Provider Enumeration Date	:	04/03/2018
Last Update Date	:	05/07/2026

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