Organization
STANISLAV KULISHOV PHYSICIAN P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STANISLAV KULISHOV MD (PRESIDENT)
(718) 627-3939
Entity
Organization
Contact information
Practice address
1833 E 13TH ST, SUITE 1A, BROOKLYN, NY 11229-2807
(718) 627-3939
(718) 627-8737
Mailing address
1833 E 13TH ST, SUITE 1A, BROOKLYN, NY 11229-2807
(718) 627-3939
(718) 627-8737
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
208948
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03475514
—
NY
Enumeration date
11/20/2006
Last updated
11/02/2012
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