Provider Demographics
NPI:1508234782
Name:GURIN, IGOR
Entity Type:Individual
Prefix:
First Name:IGOR
Middle Name:
Last Name:GURIN
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 1:3323 NOSTRAND AVE
Mailing Address - Street 2:APT#3J
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3758
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3323 NOSTRAND AVE.
Practice Address - Street 2:APT. 3J
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3726
Practice Address - Country:US
Practice Address - Phone:718-322-8121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY667041163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice