MEDICARE: MET TEK SERVICE AND MANAGEMENT INC.

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	174400000X	Specialist

General Provider Information

NPI Number	:	1184269813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MET TEK SERVICE AND MANAGEMENT INC.

Provider Business Mailing Address
First Line	:	2954 W 8TH ST APT 20B
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-3220
Country	:	US
Telephone Number	:	917-971-7728
Fax Number	:

Provider Business Practice Location Address
First Line	:	2954 W 8TH ST APT 20B
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-3220
Country	:	US
Telephone Number	:	917-971-7728
Fax Number	:

Authorized Official
Title or Position	:	SPECIAL EDUCATION TEACHER
Name	:	IGOR LOBKOV
Credential	:	MS.ED
Telephone Number	:	917-971-7728

Provider Enumeration Date	:	11/18/2019
Last Update Date	:	11/18/2019

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