Provider Demographics
NPI:1578832267
Name:NEW YORK ADVANCED LAPAROSCOPIC AND BARIATRIC SURGERY PC
Entity Type:Organization
Organization Name:NEW YORK ADVANCED LAPAROSCOPIC AND BARIATRIC SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGEY
Authorized Official - Middle Name:
Authorized Official - Last Name:TERUSHKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-616-1622
Mailing Address - Street 1:100 BEEKMAN ST
Mailing Address - Street 2:APT 12E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-1810
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:150 BRIGHTON 11TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5327
Practice Address - Country:US
Practice Address - Phone:718-616-1622
Practice Address - Fax:347-587-6861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-24
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY262892208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty