Provider Demographics
NPI:1639276314
Name:MUCHNIK, BURIJ (PA)
Entity Type:Individual
Prefix:MR
First Name:BURIJ
Middle Name:
Last Name:MUCHNIK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6957 SW 115TH PL APT D
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-1872
Mailing Address - Country:US
Mailing Address - Phone:305-274-8789
Mailing Address - Fax:
Practice Address - Street 1:3720 SW 107TH AVE STE 1
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3639
Practice Address - Country:US
Practice Address - Phone:305-554-4270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9100827363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2918404Medicaid