MEDICARE: ACCORD PHYSICIANS, PLLC

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

General Provider Information

NPI Number	:	1790949584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCORD PHYSICIANS, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 350822
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-0822
Country	:	US
Telephone Number	:	718-375-2100
Fax Number	:	718-228-7414

Provider Business Practice Location Address
First Line	:	2632 E 14TH ST
Second Line	:	SUITE 101
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3916
Country	:	US
Telephone Number	:	718-375-2100
Fax Number	:	718-228-7414

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. VITALY RAYKHMAN
Credential	:	M.D.
Telephone Number	:	718-375-2100

Provider Enumeration Date	:	07/11/2008
Last Update Date	:	05/28/2015

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