Provider Demographics
NPI:1275808404
Name:VERETILO, PAVEL (MD)
Entity Type:Individual
Prefix:DR
First Name:PAVEL
Middle Name:
Last Name:VERETILO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 SHORE PKWY APT A3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2857
Mailing Address - Country:US
Mailing Address - Phone:646-339-8380
Mailing Address - Fax:
Practice Address - Street 1:3511 SHORE PKWY APT A3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2857
Practice Address - Country:US
Practice Address - Phone:646-339-8380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2646132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry