MEDICARE: SVETLANA GAVRILOVA 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	208100000X	Physical Medicine & Rehabilitation Physician	218421	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467411918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SVETLANA GAVRILOVA MD

Provider Business Mailing Address
First Line	:	8900 VAN WYCK EXPY
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11418-2832
Country	:	US
Telephone Number	:	718-206-7820
Fax Number	:	718-206-6786

Provider Business Practice Location Address
First Line	:	8900 VAN WYCK EXPY
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11418-2832
Country	:	US
Telephone Number	:	718-206-6894
Fax Number	:	718-657-0545

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

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	01/25/2016

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