Provider Demographics
NPI:1700079621
Name:MUSHYAKOV, ARTUR ALBERTOVICH (MD)
Entity Type:Individual
Prefix:DR
First Name:ARTUR
Middle Name:ALBERTOVICH
Last Name:MUSHYAKOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97-11 HORACE HARDING EXPY
Mailing Address - Street 2:APT 12 J
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-4758
Mailing Address - Country:US
Mailing Address - Phone:718-760-1723
Mailing Address - Fax:
Practice Address - Street 1:97-11 HORACE HARDING
Practice Address - Street 2:APT 12 J
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368
Practice Address - Country:US
Practice Address - Phone:718-309-1628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY24510101207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY24510101OtherLICENSE
NYFM0367311OtherNYS DEA