Provider Demographics
NPI:1093960676
Name:ADVANCED MULTICARE MEDICAL PC
Entity Type:Organization
Organization Name:ADVANCED MULTICARE MEDICAL PC
Other - Org Name:VICTORY MULTIMED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MIKHAIL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ARTAMONOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-815-7246
Mailing Address - Street 1:25 VICTORY BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-2905
Mailing Address - Country:US
Mailing Address - Phone:718-815-7246
Mailing Address - Fax:516-706-1085
Practice Address - Street 1:25 VICTORY BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-2905
Practice Address - Country:US
Practice Address - Phone:718-815-7246
Practice Address - Fax:516-706-1085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250059208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty