Provider Demographics
NPI:1447615737
Name:GURKOV, ELIEZER (PA-C)
Entity Type:Individual
Prefix:
First Name:ELIEZER
Middle Name:
Last Name:GURKOV
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 TAMARACK LN
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-2005
Mailing Address - Country:US
Mailing Address - Phone:718-864-0963
Mailing Address - Fax:
Practice Address - Street 1:175 ROUTE 59
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-5231
Practice Address - Country:US
Practice Address - Phone:845-694-8888
Practice Address - Fax:845-501-2360
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-31
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019398363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical