Provider Demographics
NPI:1831513423
Name:SHPITALSKIY, LEV
Entity type:Individual
Prefix:
First Name:LEV
Middle Name:
Last Name:SHPITALSKIY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 VOORHIES AVE
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3912
Mailing Address - Country:US
Mailing Address - Phone:718-743-2200
Mailing Address - Fax:
Practice Address - Street 1:1523 VOORHIES AVE
Practice Address - Street 2:5TH FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3912
Practice Address - Country:US
Practice Address - Phone:718-743-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017063363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400114716Medicare PIN