Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | A98950 | CA |
Y | 207YS0123X | Facial Plastic Surgeon | 236999 | NY |
NPI | 1346398690 |
---|---|
Provider Name | Grigoriy Mashkevich |
First Address | New York, NY 10009-8925 |
Second Address | Forest Hills, NY 11375-7080 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2007 |
Last Update Date | 12/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A989500 | MEDI-CAL PPIN# (01) | CA |
I70717 | (02) | CA |