MEDICARE: DR. ALEXANDER JOSEPH PILAVSKY DDS

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	1223G0001X	General Practice Dentistry	052167	NY

General Provider Information

NPI Number	:	1164634549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDER JOSEPH PILAVSKY DDS

Provider Business Mailing Address
First Line	:	200 E 64TH ST
Second Line	:	APARTMENT 10C
City	:	NEW YORK
State	:	NY
Zip	:	10021-7426
Country	:	US
Telephone Number	:	917-375-0168
Fax Number	:

Provider Business Practice Location Address
First Line	:	810 2ND AVE
Second Line	:	C/O ILLUSTRADENT
City	:	NEW YORK
State	:	NY
Zip	:	10017-4502
Country	:	US
Telephone Number	:	212-480-2111
Fax Number	:

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

Provider Enumeration Date	:	05/05/2007
Last Update Date	:	06/05/2008

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