Provider Demographics
NPI:1174804454
Name:ADVANCED ADULT HEALTH NP, PC.
Entity type:Organization
Organization Name:ADVANCED ADULT HEALTH NP, PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:P
Authorized Official - Last Name:MORDUKHAYEV
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:718-794-1000
Mailing Address - Street 1:2109 MATTHEWS AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-2614
Mailing Address - Country:US
Mailing Address - Phone:718-794-1000
Mailing Address - Fax:718-794-5264
Practice Address - Street 1:2109 MATTHEWS AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-2614
Practice Address - Country:US
Practice Address - Phone:718-794-1000
Practice Address - Fax:718-794-5264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-31
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty