Provider Demographics
NPI:1881252781
Name:PYATIG MEDICAL PC
Entity type:Organization
Organization Name:PYATIG MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PYATIGORSKAYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-933-9091
Mailing Address - Street 1:3412 AVENUE T
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4913
Mailing Address - Country:US
Mailing Address - Phone:347-933-9091
Mailing Address - Fax:
Practice Address - Street 1:3412 AVENUE T
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-4913
Practice Address - Country:US
Practice Address - Phone:347-933-9091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY162150398Medicaid