Provider Demographics
NPI:1962550699
Name:MURTEZANI, SKENDER (MD)
Entity type:Individual
Prefix:
First Name:SKENDER
Middle Name:
Last Name:MURTEZANI
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 1:1434 110TH ST APT 4G
Mailing Address - Street 2:
Mailing Address - City:COLLEGE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11356-1445
Mailing Address - Country:US
Mailing Address - Phone:718-674-4646
Mailing Address - Fax:
Practice Address - Street 1:5516 MAIN ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5098
Practice Address - Country:US
Practice Address - Phone:718-461-3065
Practice Address - Fax:718-461-3590
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236980207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02677530Medicaid
NYI36633Medicare UPIN