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Organization
LONDON MEDICAL DIAGNOSTIC PC
Active
Organization
LONDON MEDICAL DIAGNOSTIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ILYA Y BURSHTEYN MD (MD/CEO)
(718) 459-3494
Entity
Organization
Contact information
Practice address
10525 64TH AVE, FOREST HILLS, NY 11375-1640
(718) 459-3494
(718) 606-6069
Mailing address
10525 64TH AVE, FOREST HILLS, NY 11375-1640
(718) 459-3494
(718) 606-6069
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
215638
NY
207R00000X
Internal Medicine Physician
Primary
—
—
213E00000X
Podiatrist
—
—
225100000X
Physical Therapist
—
—
363AM0700X
Medical Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03272777
—
NY
Enumeration date
08/18/2008
Last updated
06/19/2023
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