Provider Demographics
NPI:1194961078
Name:KORSHUNOV, YEVGENIY A (MD)
Entity type:Individual
Prefix:
First Name:YEVGENIY
Middle Name:A
Last Name:KORSHUNOV
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 1:1551 RICHMOND RD STE 1A
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-2338
Mailing Address - Country:US
Mailing Address - Phone:718-727-6945
Mailing Address - Fax:718-727-6958
Practice Address - Street 1:1551 RICHMOND RD STE 1A
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-2338
Practice Address - Country:US
Practice Address - Phone:718-727-6945
Practice Address - Fax:718-727-6958
Is Sole Proprietor?:No
Enumeration Date:2008-12-26
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY269467207XS0114X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery