MEDICARE: DR. SVETLANA SPIVAK MD

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	208000000X	Pediatrics Physician	210760	NY

General Provider Information

NPI Number	:	1447233069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SVETLANA SPIVAK MD

Provider Business Mailing Address
First Line	:	8631 14TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-3413
Country	:	US
Telephone Number	:	718-258-9888
Fax Number	:	347-462-4257

Provider Business Practice Location Address
First Line	:	2287 NOSTRAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-3029
Country	:	US
Telephone Number	:	718-258-9888
Fax Number	:	347-462-4257

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

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	10/19/2010

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