MEDICARE: DR. LITA LYAKHOVETSKAYA 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	2084P0800X	Psychiatry Physician	210933	NY

General Provider Information

NPI Number	:	1164598561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LITA LYAKHOVETSKAYA M.D.

Provider Business Mailing Address
First Line	:	17 CLOVER HILL DR
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06902-1601
Country	:	US
Telephone Number	:	203-357-9194
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 NORTH AVE
Second Line	:	2ND FLOOR
City	:	NEW ROCHELLE
State	:	NY
Zip	:	10801-4160
Country	:	US
Telephone Number	:	914-633-8842
Fax Number	:	914-633-8947

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	07/08/2007

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