Provider Demographics
NPI:1851464853
Name:MORDUKHAYEV, ERIK P (NP)
Entity Type:Individual
Prefix:MR
First Name:ERIK
Middle Name:P
Last Name:MORDUKHAYEV
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6395 AUSTIN ST
Mailing Address - Street 2:APT 2 F
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3051
Mailing Address - Country:US
Mailing Address - Phone:646-334-1324
Mailing Address - Fax:
Practice Address - Street 1:15705 CROSSBAY BLVD
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-2748
Practice Address - Country:US
Practice Address - Phone:718-845-5252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303815363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health