Healthcare Provider Details

I. General information

NPI: 1013099126
Provider Name (Legal Business Name): LYUDMILA GABRIEL CAVALIER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYUDMILA YUSHVAYEV MD

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9014 FLATLANDS AVENUE LYUDMILA CAVALIER PHYSICIAN PC
BROOKLYN NY
11236
US

IV. Provider business mailing address

9014 FLATLANDS AVENUE LYUDMILA CAVALIER PHYSICIAN PC
BROOKLYN NY
11236
US

V. Phone/Fax

Practice location:
  • Phone: 718-209-5353
  • Fax: 718-209-1745
Mailing address:
  • Phone: 718-209-5353
  • Fax: 718-209-1745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number207531
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: