Individual ProviderRichard NiyazovEmergency MedicineAllopathic & Osteopathic PhysiciansPractice Address101 Nicolls Road Hsc, Hsc Level 4, 050, Stony Brook, NY 11794(631) 444-3880PECOS EnrollmentBased on the most recent information from CMS, provider Richard Niyazov is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 4 days ago.Profile DetailsProvider ID1538745278Provider TypeIndividualFull NameNiyazov, RichardTitleDr.CredentialDOGenderMaleSole ProprietorNoEnumeration Date3/23/2021Last Updated6/6/2024Contact InformationPractice LocationPractice Address101 Nicolls Road Hsc, Hsc Level 4, 050, Stony Brook, NY 11794Phone(631) 444-3880Fax(631) 444-3919Mailing LocationMailing Address101 Nicolls Road Hsc, Hsc Level 4, 050, Stony Brook, NY 11794Phone(631) 444-3880Fax(631) 444-3919Provider TaxonomiesCodeDescriptionLicenseCode207P00000XPrimaryDescriptionEmergency MedicineAllopathic & Osteopathic PhysiciansLicense33008301New YorkCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer