Provider Demographics
NPI:1750636221
Name:NP IN ADULT HEALTH DIAGNOSTIC AND TREATMENT, PLLC
Entity Type:Organization
Organization Name:NP IN ADULT HEALTH DIAGNOSTIC AND TREATMENT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:E
Authorized Official - Last Name:ISTOMIN MD
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MS, MS
Authorized Official - Phone:718-554-1150
Mailing Address - Street 1:8708 JUSTICE AVE
Mailing Address - Street 2:2E
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4575
Mailing Address - Country:US
Mailing Address - Phone:718-554-1150
Mailing Address - Fax:
Practice Address - Street 1:8708 JUSTICE AVE
Practice Address - Street 2:2E
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4575
Practice Address - Country:US
Practice Address - Phone:718-554-1150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-19
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304254146N00000X, 163WD0400X, 163WG0000X
NY533201163W00000X
ZZ242862207P00000X, 2083P0901X
NY33D1092118291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Multi-Specialty
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty