Provider Demographics
NPI:1942529367
Name:GURSHUMOV, EMIL L (MD)
Entity Type:Individual
Prefix:DR
First Name:EMIL
Middle Name:L
Last Name:GURSHUMOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3049 BRIGHTON 6TH ST
Mailing Address - Street 2:UNIT CU 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3020
Mailing Address - Country:US
Mailing Address - Phone:646-633-3833
Mailing Address - Fax:718-934-0994
Practice Address - Street 1:3049 BRIGHTON 6TH ST
Practice Address - Street 2:UNIT CU 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3020
Practice Address - Country:US
Practice Address - Phone:718-934-0322
Practice Address - Fax:718-934-0994
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2015-08-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY265211207VF0040X, 207VF0040X
NJ25MA08762100207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03624004Medicaid
NYA400093981Medicare PIN