Healthcare Provider Details

I. General information

NPI: 1881530285
Provider Name (Legal Business Name): 1771 UTICA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1771 UTICA AVE
BROOKLYN NY
11234-2120
US

IV. Provider business mailing address

1771 UTICA AVE
BROOKLYN NY
11234-2120
US

V. Phone/Fax

Practice location:
  • Phone: 917-933-4333
  • Fax: 917-933-4330
Mailing address:
  • Phone: 917-933-4333
  • Fax: 917-933-4330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIL SHABATAY
Title or Position: PRESIDENT./CEO
Credential:
Phone: 917-933-4333