Provider Demographics
NPI:1053063644
Name:5TH AVENUE WELLNESS MEDICINE PC
Entity Type:Organization
Organization Name:5TH AVENUE WELLNESS MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NAYSHTUT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-989-9595
Mailing Address - Street 1:1049 5TH AVE STE 1A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0115
Mailing Address - Country:US
Mailing Address - Phone:646-229-4926
Mailing Address - Fax:
Practice Address - Street 1:1049 5TH AVE STE 1A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0115
Practice Address - Country:US
Practice Address - Phone:718-989-9595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-25
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty