MEDICARE: GENNADIY KRAVETS D.M.D.

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	122300000X	Dentist	052594-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144492687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENNADIY KRAVETS D.M.D.

Provider Business Mailing Address
First Line	:	202 UNION AVE
Second Line	:	SUITE D
City	:	BROOKLYN
State	:	NY
Zip	:	11211-7467
Country	:	US
Telephone Number	:	718-388-4613
Fax Number	:	718-388-4613

Provider Business Practice Location Address
First Line	:	202 UNION AVE
Second Line	:	SUITE D
City	:	BROOKLYN
State	:	NY
Zip	:	11211-7467
Country	:	US
Telephone Number	:	718-388-4613
Fax Number	:	718-388-4613

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

Provider Enumeration Date	:	03/25/2008
Last Update Date	:	03/25/2008

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