Provider Demographics
NPI:1477711885
Name:IHOR MAGUN MD
Entity type:Organization
Organization Name:IHOR MAGUN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IHOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-766-5147
Mailing Address - Street 1:2000 NORTH VILLAGE AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570
Mailing Address - Country:US
Mailing Address - Phone:516-766-5147
Mailing Address - Fax:516-766-5483
Practice Address - Street 1:2000 NORTH VILLAGE AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570
Practice Address - Country:US
Practice Address - Phone:516-766-5147
Practice Address - Fax:516-766-5483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164151207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
10E061Medicare Oscar/Certification
E44626Medicare UPIN