Provider Demographics
NPI:1346660867
Name:AVANGUARD MEDICAL GROUP
Entity Type:Organization
Organization Name:AVANGUARD MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIGALOVA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:917-453-5884
Mailing Address - Street 1:2076 E 13TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3304
Mailing Address - Country:US
Mailing Address - Phone:718-382-7900
Mailing Address - Fax:718-382-7901
Practice Address - Street 1:2076 E 13TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3304
Practice Address - Country:US
Practice Address - Phone:718-382-7900
Practice Address - Fax:718-382-7901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY675855261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain