Provider Demographics
NPI:1689708190
Name:ADVANCED PRACTICE OF MEDICINE PC
Entity Type:Organization
Organization Name:ADVANCED PRACTICE OF MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:YEVGENIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:RABOVETSKAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-942-5385
Mailing Address - Street 1:3101 OCEAN PKWY APT 1E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-8412
Mailing Address - Country:US
Mailing Address - Phone:718-942-5385
Mailing Address - Fax:
Practice Address - Street 1:3101 OCEAN PKWY APT 1E
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8412
Practice Address - Country:US
Practice Address - Phone:718-942-5385
Practice Address - Fax:718-942-5377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207452174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01893030Medicaid
IN060609000000OtherCENTER CARE
NY182219OtherDC1707
NYG82836OtherMULTIPLAN
NY207452OtherHIP
NYPR51792530001OtherCIGNA
NY207452A79OtherHEALTH FIRST
NY2386025OtherAETNA HMO
NYBK0093510OtherAMERICHOICE
NY219AK2OtherEMPIRE BCBS
NYP1874886OtherOXFORD
NYRY7452OtherATLANTIS
NY2514433OtherGHI PPO
NY3C3729OtherHEALTHNET
NYRY7452OtherATLANTIS
NY=========OtherMETRO PLUS
NY01893030Medicaid
NYP1874886OtherOXFORD
NYYR041N7910Medicare ID - Type Unspecified