MEDICARE: NYC PSYCHIATRIST PC

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	242883	NY

General Provider Information

NPI Number	:	1386026961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NYC PSYCHIATRIST PC

Provider Business Mailing Address
First Line	:	122 E 25TH ST
Second Line	:	GROUND LEVEL, WEST ENTRANCE
City	:	NEW YORK
State	:	NY
Zip	:	10010-2936
Country	:	US
Telephone Number	:	917-704-4069
Fax Number	:

Provider Business Practice Location Address
First Line	:	122 E 25TH ST
Second Line	:	GROUND LEVEL, WEST ENTRANCE
City	:	NEW YORK
State	:	NY
Zip	:	10010-2936
Country	:	US
Telephone Number	:	917-704-4069
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	ZLATIN IVANOV
Credential	:
Telephone Number	:	917-704-4069

Provider Enumeration Date	:	06/19/2015
Last Update Date	:	06/22/2015

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Directions to “NYC PSYCHIATRIST PC ” Practice Location

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