Provider Demographics
NPI:1629854492
Name:MANASHIR RUVINOV FAMILY HEALTH NP PC
Entity Type:Organization
Organization Name:MANASHIR RUVINOV FAMILY HEALTH NP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANASHIR
Authorized Official - Middle Name:
Authorized Official - Last Name:RUVINOV
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:917-545-2292
Mailing Address - Street 1:1375 CONEY ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-4166
Mailing Address - Country:US
Mailing Address - Phone:917-545-2292
Mailing Address - Fax:
Practice Address - Street 1:419 HUMBOLDT ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-2898
Practice Address - Country:US
Practice Address - Phone:917-545-2292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty