MEDICARE: IGOR KESELMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	049601	NY

General Provider Information

NPI Number	:	1114184397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IGOR KESELMAN

Provider Business Mailing Address
First Line	:	6716 18TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-4301
Country	:	US
Telephone Number	:	718-232-2288
Fax Number	:	718-232-0034

Provider Business Practice Location Address
First Line	:	6716 18TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-4301
Country	:	US
Telephone Number	:	718-232-2288
Fax Number	:	718-232-0034

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2008
Last Update Date	:	05/16/2008

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Directions to “ IGOR KESELMAN ” Practice Location

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