Provider Demographics
NPI:1013208164
Name:MYKHALCHUK, RUSLAN (RN)
Entity Type:Individual
Prefix:
First Name:RUSLAN
Middle Name:
Last Name:MYKHALCHUK
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2955 AVENUE X APT 3E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1853
Mailing Address - Country:US
Mailing Address - Phone:718-232-0757
Mailing Address - Fax:
Practice Address - Street 1:2955 AVENUE X APT 3E
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-1853
Practice Address - Country:US
Practice Address - Phone:718-232-0757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY637330163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse