Healthcare Provider Details

I. General information

NPI: 1265633598
Provider Name (Legal Business Name): BDF PEDIATRIC GROUP LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2647 CONEY ISLAND AVE
BROOKLYN NY
11223-5502
US

IV. Provider business mailing address

2647 CONEY ISLAND AVE
BROOKLYN NY
11223-5502
US

V. Phone/Fax

Practice location:
  • Phone: 718-891-1551
  • Fax: 718-368-1177
Mailing address:
  • Phone: 718-891-1551
  • Fax: 718-368-1177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number208922
License Number StateNY

VIII. Authorized Official

Name: MS. LILYA DAREVSKAYA
Title or Position: PROVIDER
Credential: D.O
Phone: 718-891-1551