Basic Information
| Provider Information | |||||||||
| NPI: | 1851464853 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MORDUKHAYEV | ||||||||
| FirstName: | ERIK | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6395 AUSTIN ST | ||||||||
| Address2: | APT 2 F | ||||||||
| City: | REGO PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113743051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6463341324 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15705 CROSSBAY BLVD | ||||||||
| Address2: | |||||||||
| City: | HOWARD BEACH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114142748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188455252 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2006 | ||||||||
| LastUpdateDate: | 10/09/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 303815 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.