Crescent Medical Care PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

221766 Issued in NY

Legal business name

CRESCENT MEDICAL CARE PC

Practice address

6425 Ellwell Crscent
Rego Park, NY 11374

Phone

(718) 997-6400

Fax

(718) 997-6405

NPI assigned

Jul 20, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Vyacheslav Galibov, MD

Title

Owner

Phone

(718) 997-6400

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1248048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248048000000",
    "number": "1760612246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6425 ELLWELL CRSCENT",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "11374",
            "telephone_number": "718-997-6400",
            "fax_number": "718-997-6405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6425 ELLWELL CRSCENT",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "11374",
            "telephone_number": "718-997-6400",
            "fax_number": "718-997-6405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESCENT MEDICAL CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-20",
        "last_updated": "2009-07-20",
        "status": "A",
        "authorized_official_last_name": "GALIBOV",
        "authorized_official_first_name": "VYACHESLAV",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-997-6400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "221766",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02196050",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Rego Park, NY
• Providers in Rego Park, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.