| Luiza Guseynov,physician,pllc | |
|
3108 Kingsbridge Ave Ground Floor,office B Bronx NY 10463-3956 | |
| (718) 432-0200 | |
| (718) 432-0201 |
| Full Name | Luiza Guseynov,physician,pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3108 Kingsbridge Ave, Bronx, New York |
| Authorized Official Name and Position | Luiza Guseynov (PHYSICIAN) |
| Authorized Official Contact | 7184320200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Luiza Guseynov,physician,pllc 16832 Powells Cove Blvd Whitestone NY 11357-1523 Ph: (718) 432-0200 | Luiza Guseynov,physician,pllc 3108 Kingsbridge Ave Ground Floor,office B Bronx NY 10463-3956 Ph: (718) 432-0200 |
| NPI Number | 1629384342 |
|---|---|
| Provider Enumeration Date | 08/19/2010 |
| Last Update Date | 08/19/2010 |
| Medicare PECOS PAC ID | 4385692896 |
|---|---|
| Medicare Enrollment ID | O20050111000380 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629384342 | NPI | - | NPPES |
| 02625643 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 233370 (New York) | Primary |
| Provider Name | Luiza Guseynov |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114994134 PECOS PAC ID: 0648228270 Enrollment ID: I20050110001005 |
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