Organization
SUPREME MEDICAL DIAGNOSTIC,P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ILYA Y BURSHTEYN M.D., (OWNER)
(212) 288-3474
Entity
Organization
Contact information
Practice address
215 E 68TH ST, SUITE 8, NEW YORK, NY 10065-5718
(212) 288-2553
Mailing address
215 E 68TH ST, SUITE 8, NEW YORK, NY 10065-5718
(212) 288-2553
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
05/07/2009
Last updated
05/09/2009
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