Provider Demographics
NPI:1346563582
Name:ADVANCED PHYSICIANS P C
Entity Type:Organization
Organization Name:ADVANCED PHYSICIANS P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUSTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-360-9550
Mailing Address - Street 1:6915 YELLOWSTONE BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3787
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6915 YELLOWSTONE BLVD STE 4
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3787
Practice Address - Country:US
Practice Address - Phone:718-360-9550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-02
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY244228OtherLICENSE
NY08313Medicare PIN