MEDICARE: YOUR CHOICE MEDICAL PC

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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	203762	NY

General Provider Information

NPI Number	:	1770811952
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUR CHOICE MEDICAL PC

Provider Business Mailing Address
First Line	:	2912 AVENUE X
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-1906
Country	:	US
Telephone Number	:	718-743-7090
Fax Number	:	718-743-7581

Provider Business Practice Location Address
First Line	:	2912 AVENUE X
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-1906
Country	:	US
Telephone Number	:	718-743-7090
Fax Number	:	718-743-7581

Authorized Official
Title or Position	:	PRESIDENT
Name	:	REGINA GUREVICH
Credential	:	MD
Telephone Number	:	718-743-7090

Provider Enumeration Date	:	11/25/2009
Last Update Date	:	11/25/2009

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