Healthcare Provider Details

I. General information

NPI: 1740423508
Provider Name (Legal Business Name): NATHALIA IDELEVITCH MEDICAL OFFICE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2009
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3048 BRIGHTON 1ST ST STE 2
BROOKLYN NY
11235-8081
US

IV. Provider business mailing address

3048 BRIGHTON 1ST ST STE 2
BROOKLYN NY
11235-8081
US

V. Phone/Fax

Practice location:
  • Phone: 347-702-9531
  • Fax: 347-702-6045
Mailing address:
  • Phone: 347-702-9531
  • Fax: 347-702-6045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NATHALIA IDELEVITCH
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 917-627-5470