MEDICARE: MILA MOGILEVSKY DO

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	36116446	IL
2	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	251416	NY

General Provider Information

NPI Number	:	1518152305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILA MOGILEVSKY DO

Provider Business Mailing Address
First Line	:	1204 AVENUE U STE 1075
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4107
Country	:	US
Telephone Number	:	347-252-6732
Fax Number	:

Provider Business Practice Location Address
First Line	:	626 SHEEPSHEAD BAY RD STE 520
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-3606
Country	:	US
Telephone Number	:	929-363-0303
Fax Number	:	929-363-0399

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

Provider Enumeration Date	:	09/13/2007
Last Update Date	:	06/10/2024

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