Provider Demographics
NPI:1013099126
Name:CAVALIER, LYUDMILA GABRIEL (MD)
Entity Type:Individual
Prefix:
First Name:LYUDMILA
Middle Name:GABRIEL
Last Name:CAVALIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LYUDMILA
Other - Middle Name:
Other - Last Name:YUSHVAYEV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9014 FLATLANDS AVENUE
Mailing Address - Street 2:LYUDMILA CAVALIER PHYSICIAN PC
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236
Mailing Address - Country:US
Mailing Address - Phone:718-209-5353
Mailing Address - Fax:718-209-1745
Practice Address - Street 1:9014 FLATLANDS AVENUE
Practice Address - Street 2:LYUDMILA CAVALIER PHYSICIAN PC
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236
Practice Address - Country:US
Practice Address - Phone:718-209-5353
Practice Address - Fax:718-209-1745
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207531208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01828239Medicaid
NY01828239Medicaid
06193GMedicare ID - Type Unspecified