Provider Demographics
NPI:1104124841
Name:PRO-HEALTH MEDICAL, P.C.
Entity type:Organization
Organization Name:PRO-HEALTH MEDICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTUR
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSHYAKOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-309-1628
Mailing Address - Street 1:6511 BOOTH ST
Mailing Address - Street 2:SUITE 1 A
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4181
Mailing Address - Country:US
Mailing Address - Phone:718-309-1628
Mailing Address - Fax:
Practice Address - Street 1:6511 BOOTH ST
Practice Address - Street 2:SUITE 1 A
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4181
Practice Address - Country:US
Practice Address - Phone:718-309-1628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty