1689708190 NPI number — ADVANCED PRACTICE OF MEDICINE PC

Table of content: (NPI 1689708190)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689708190 NPI number — ADVANCED PRACTICE OF MEDICINE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED PRACTICE OF MEDICINE PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689708190
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3101 OCEAN PKWY APT 1E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11235-8412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-942-5385
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3101 OCEAN PKWY APT 1E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11235-8412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-942-5385
Provider Business Practice Location Address Fax Number:
718-942-5377
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RABOVETSKAYA
Authorized Official First Name:
YEVGENIYA
Authorized Official Middle Name:
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
718-942-5385

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  207452 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01893030 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060609000000 . This is a "CENTER CARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 182219 . This is a "DC1707" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: G82836 . This is a "MULTIPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 207452 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: PR51792530001 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 207452A79 . This is a "HEALTH FIRST" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2386025 . This is a "AETNA HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: BK0093510 . This is a "AMERICHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 219AK2 . This is a "EMPIRE BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P1874886 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: RY7452 . This is a "ATLANTIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2514433 . This is a "GHI PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3C3729 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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