MEDICARE: MR. PAVEL YANKELEVICH C.PED., CFO

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	174400000X	Specialist	10709	NY

General Provider Information

NPI Number	:	1528018983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAVEL YANKELEVICH C.PED., CFO

Provider Business Mailing Address
First Line	:	2962 AVENUE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-5101
Country	:	US
Telephone Number	:	718-743-2453
Fax Number	:	718-743-2352

Provider Business Practice Location Address
First Line	:	2962 AVENUE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-5101
Country	:	US
Telephone Number	:	718-743-2453
Fax Number	:	718-743-2352

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	07/08/2007

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