Provider Demographics
NPI:1598276297
Name:GEROVICH, YEVGENIY
Entity Type:Individual
Prefix:
First Name:YEVGENIY
Middle Name:
Last Name:GEROVICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1733 SHEEPSHEAD BAY RD STE 12
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3728
Mailing Address - Country:US
Mailing Address - Phone:718-975-7730
Mailing Address - Fax:718-975-7728
Practice Address - Street 1:1733 SHEEPSHEAD BAY RD STE 12
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3728
Practice Address - Country:US
Practice Address - Phone:718-975-7730
Practice Address - Fax:718-975-7728
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-20
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1623L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1720460405OtherMLTC