Provider Demographics
NPI:1790952570
Name:BEAUTIFUL MIND MEDICAL, PC
Entity Type:Organization
Organization Name:BEAUTIFUL MIND MEDICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHISICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:VALERIY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERNOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-253-1087
Mailing Address - Street 1:2218 KIMBALL ST
Mailing Address - Street 2:SUITE M5
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5103
Mailing Address - Country:US
Mailing Address - Phone:718-253-1087
Mailing Address - Fax:718-253-7774
Practice Address - Street 1:2218 KIMBALL ST
Practice Address - Street 2:SUITE M5
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5103
Practice Address - Country:US
Practice Address - Phone:718-253-1087
Practice Address - Fax:718-253-7774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232633103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty