Provider Demographics
NPI:1790775070
Name:YEVGENIYA KARMAZIN MEDICAL PC
Entity Type:Organization
Organization Name:YEVGENIYA KARMAZIN MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YEVGENIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KARMAZIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-891-5100
Mailing Address - Street 1:2 BIRCH DR
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-2615
Mailing Address - Country:US
Mailing Address - Phone:516-374-0974
Mailing Address - Fax:516-374-0978
Practice Address - Street 1:3084 BRIGHTON 13TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5608
Practice Address - Country:US
Practice Address - Phone:718-891-5100
Practice Address - Fax:718-891-8810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198112174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01549926Medicaid
NYW38771Medicare PIN