Provider Demographics
NPI:1083792782
Name:DAVIDOV, YVETTE (DO)
Entity Type:Individual
Prefix:DR
First Name:YVETTE
Middle Name:
Last Name:DAVIDOV
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 OCEAN PKWY APT 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-4075
Mailing Address - Country:US
Mailing Address - Phone:718-252-5300
Mailing Address - Fax:718-252-5010
Practice Address - Street 1:1115 OCEAN PKWY APT 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-4075
Practice Address - Country:US
Practice Address - Phone:718-252-5300
Practice Address - Fax:718-252-5010
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216589-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine