Provider Demographics
NPI:1609087329
Name:POVLOSKI, MARGARET JOSEPHINE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:JOSEPHINE
Last Name:POVLOSKI
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:MRS
Other - First Name:MARGARITA
Other - Middle Name:
Other - Last Name:POVOLOTSKAYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICIAN ASSISTANT
Mailing Address - Street 1:1213 AVE Z
Mailing Address - Street 2:APT D36
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235
Mailing Address - Country:US
Mailing Address - Phone:917-974-0504
Mailing Address - Fax:
Practice Address - Street 1:ONE BROOKDALE PLAZA
Practice Address - Street 2:BROOKDALE HOSPITAL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-3198
Practice Address - Country:US
Practice Address - Phone:718-240-5363
Practice Address - Fax:718-240-5042
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0061501363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant