Provider Demographics
NPI:1740423508
Name:NATHALIA IDELEVITCH MEDICAL OFFICE PC
Entity Type:Organization
Organization Name:NATHALIA IDELEVITCH MEDICAL OFFICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:IDELEVITCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-627-5470
Mailing Address - Street 1:3048 BRIGHTON 1ST ST STE 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-8081
Mailing Address - Country:US
Mailing Address - Phone:347-702-9531
Mailing Address - Fax:347-702-6045
Practice Address - Street 1:3048 BRIGHTON 1ST ST STE 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8081
Practice Address - Country:US
Practice Address - Phone:347-702-9531
Practice Address - Fax:347-702-6045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-09
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100076270Medicare PIN