Provider Demographics
NPI:1710624630
Name:ZAGORODNEV, KIRILL (MD)
Entity Type:Individual
Prefix:MR
First Name:KIRILL
Middle Name:
Last Name:ZAGORODNEV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 HEMPSTEAD TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:EAST MEDOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554
Mailing Address - Country:US
Mailing Address - Phone:516-572-6501
Mailing Address - Fax:516-572-6501
Practice Address - Street 1:2201 HEMPSTEAD TURNPIKE
Practice Address - Street 2:
Practice Address - City:EAST MEDOW
Practice Address - State:NY
Practice Address - Zip Code:11554
Practice Address - Country:US
Practice Address - Phone:516-572-6501
Practice Address - Fax:516-572-6501
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-13
Last Update Date:2023-01-30
Deactivation Date:2023-01-13
Deactivation Code:
Reactivation Date:2023-01-30
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program