MEDICARE: LYDIG PEDIATRICS 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	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1861732547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LYDIG PEDIATRICS PC

Provider Business Mailing Address
First Line	:	627 LYDIG AVE
Second Line	:	1 ST FLOOR
City	:	BRONX
State	:	NY
Zip	:	10462-2283
Country	:	US
Telephone Number	:	718-772-0070
Fax Number	:	718-709-7028

Provider Business Practice Location Address
First Line	:	627 LYDIG AVE
Second Line	:	1 ST FLOOR
City	:	BRONX
State	:	NY
Zip	:	10462-2283
Country	:	US
Telephone Number	:	718-772-0070
Fax Number	:	718-709-7028

Authorized Official
Title or Position	:	OWNER
Name	:	DR. NATALIYA KRIVITSKAYA
Credential	:	MD
Telephone Number	:	718-772-0070

Provider Enumeration Date	:	02/18/2013
Last Update Date	:	03/17/2014

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