Provider Demographics
NPI:1043341324
Name:ADVANCED PSYCHIATRIC CARE PC
Entity Type:Organization
Organization Name:ADVANCED PSYCHIATRIC CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHARITONOVA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-238-2285
Mailing Address - Street 1:345 82ND STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209
Mailing Address - Country:US
Mailing Address - Phone:718-238-2285
Mailing Address - Fax:718-332-7412
Practice Address - Street 1:99 BRIGHTON 11 STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235
Practice Address - Country:US
Practice Address - Phone:718-238-2285
Practice Address - Fax:718-332-7412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2089422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY64M551Medicare PIN
NJ098241Medicare PIN