Provider Demographics
NPI:1740560713
Name:TATIANA A PAVLOVA-GREENFIELD PHYSICIAN PC
Entity Type:Organization
Organization Name:TATIANA A PAVLOVA-GREENFIELD PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TATIANA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAVLOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-927-0333
Mailing Address - Street 1:521 5TH AVE
Mailing Address - Street 2:STE 1703
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10175-0003
Mailing Address - Country:US
Mailing Address - Phone:212-927-0333
Mailing Address - Fax:212-927-0335
Practice Address - Street 1:601 W 177TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-7152
Practice Address - Country:US
Practice Address - Phone:212-927-0333
Practice Address - Fax:212-927-0335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty