Provider Demographics
NPI:1558729665
Name:FILTON LLC
Entity Type:Organization
Organization Name:FILTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANTON
Authorized Official - Middle Name:
Authorized Official - Last Name:GUREVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-554-3862
Mailing Address - Street 1:3079 BRIGHTON 13TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5607
Mailing Address - Country:US
Mailing Address - Phone:718-554-3862
Mailing Address - Fax:718-554-0979
Practice Address - Street 1:3079 BRIGHTON 13TH ST FL 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5607
Practice Address - Country:US
Practice Address - Phone:718-554-3862
Practice Address - Fax:718-554-0979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-03
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100139533Medicare PIN