MEDICARE: YEVGENIY A KORSHUNOV 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	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	269467	NY
2	207X00000X	Orthopaedic Surgery Physician	269467	NY

General Provider Information

NPI Number	:	1194961078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YEVGENIY A KORSHUNOV MD

Provider Business Mailing Address
First Line	:	1551 RICHMOND RD STE 1A
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-2338
Country	:	US
Telephone Number	:	718-727-6945
Fax Number	:	718-727-6958

Provider Business Practice Location Address
First Line	:	1551 RICHMOND RD STE 1A
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-2338
Country	:	US
Telephone Number	:	718-727-6945
Fax Number	:	718-727-6958

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

Provider Enumeration Date	:	12/26/2008
Last Update Date	:	05/13/2024

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