Provider Demographics
NPI:1235185778
Name:ISTOMIN MD, ALEXANDER EUGENE (MD, MS, MS)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:EUGENE
Last Name:ISTOMIN MD
Suffix:
Gender:M
Credentials:MD, MS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-0095
Mailing Address - Country:US
Mailing Address - Phone:718-554-7434
Mailing Address - Fax:718-554-1666
Practice Address - Street 1:8708 JUSTICE AVE
Practice Address - Street 2:SUITE 2E
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4575
Practice Address - Country:US
Practice Address - Phone:718-554-7434
Practice Address - Fax:718-554-1666
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9238727363L00000X
NYF304254363LA2200X
ZZ242862207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health