Provider Demographics
NPI:1477533529
Name:MURRAY, CYRUS A
Entity Type:Individual
Prefix:
First Name:CYRUS
Middle Name:A
Last Name:MURRAY
Suffix:
Gender:M
Credentials:
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 250142
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-0142
Mailing Address - Country:US
Mailing Address - Phone:718-282-0100
Mailing Address - Fax:
Practice Address - Street 1:28 MAPLE ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-5002
Practice Address - Country:US
Practice Address - Phone:718-282-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150336174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00906854Medicaid
NYE69915Medicare UPIN
NY72F221Medicare ID - Type Unspecified