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NPI Code Detail

MEDICARE: EDUARD DOTLIBOV

MEDICARE: EDUARD DOTLIBOV
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
1363LA2200XAdult Health Nurse PractitionerF306395NY

General Provider Information

NPI Number : 1467795708
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDUARD DOTLIBOV
Provider Business Mailing Address
First Line : 2714 MERMAID AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11224-2006
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2714 MERMAID AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11224-2006
Country : US
Telephone Number : 718-373-8961
Fax Number : 718-373-8963
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2013
Last Update Date : 04/05/2013

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Directions to “ EDUARD DOTLIBOV ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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