Provider Demographics
NPI:1932531340
Name:EMIL GURSHUMOV MEDICAL P.C.
Entity Type:Organization
Organization Name:EMIL GURSHUMOV MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMIL
Authorized Official - Middle Name:L
Authorized Official - Last Name:GURSHUMOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-934-0322
Mailing Address - Street 1:1811 QUENTIN RD
Mailing Address - Street 2:APT 2D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1343
Mailing Address - Country:US
Mailing Address - Phone:646-633-3833
Mailing Address - Fax:
Practice Address - Street 1:2265 OCEAN PKWY
Practice Address - Street 2:APT 2B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-5149
Practice Address - Country:US
Practice Address - Phone:718-934-0322
Practice Address - Fax:718-934-0994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-08
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY265211207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive SurgeryGroup - Single Specialty