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NPI Code Detail

MEDICARE: MR. SERGEY TSIRLIN MPA-C

MEDICARE: MR. SERGEY TSIRLIN MPA-C
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
1363AS0400XSurgical Physician Assistant008664NY

General Provider Information

NPI Number : 1245492214
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SERGEY TSIRLIN MPA-C
Provider Business Mailing Address
First Line : 450 CLARKSON AVE
Second Line : BOX 1189
City : BROOKLYN
State : NY
Zip : 11203-2056
Country : US
Telephone Number : 718-270-6363
Fax Number :
Provider Business Practice Location Address
First Line : 450 CLARKSON AVE
Second Line : BOX 1189
City : BROOKLYN
State : NY
Zip : 11203-2056
Country : US
Telephone Number : 718-270-6363
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2008
Last Update Date : 06/30/2008

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