Provider Demographics
NPI:1649591306
Name:AVE U MEDICAL PC
Entity Type:Organization
Organization Name:AVE U MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIPP
Authorized Official - Middle Name:
Authorized Official - Last Name:PIFKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-934-9720
Mailing Address - Street 1:2153 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-4030
Mailing Address - Country:US
Mailing Address - Phone:718-339-9438
Mailing Address - Fax:718-339-3251
Practice Address - Street 1:2153 E 3RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-4030
Practice Address - Country:US
Practice Address - Phone:718-339-9438
Practice Address - Fax:718-339-3251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226668207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02351251Medicaid
NY091AX1Medicare UPIN