Provider Demographics
NPI:1790003374
Name:SAVI MUSHIYEV MD PC
Entity Type:Organization
Organization Name:SAVI MUSHIYEV MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING REP
Authorized Official - Prefix:MS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-366-0390
Mailing Address - Street 1:10250 62ND RD
Mailing Address - Street 2:APT 3G
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1056
Mailing Address - Country:US
Mailing Address - Phone:718-275-2224
Mailing Address - Fax:631-366-0391
Practice Address - Street 1:6260 108TH ST
Practice Address - Street 2:1J
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1356
Practice Address - Country:US
Practice Address - Phone:718-275-2224
Practice Address - Fax:631-366-0391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240021207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03162338Medicaid
NYA400018611OtherMEDICARE PTAN INDIVIDUAL