Healthcare Provider Details

I. General information

NPI: 1497755029
Provider Name (Legal Business Name): FAINA URITSKAYA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 E 13TH ST
BROOKLYN NY
11229-1101
US

IV. Provider business mailing address

50 PELICAN CIR
STATEN ISLAND NY
10306-4566
US

V. Phone/Fax

Practice location:
  • Phone: 718-339-6300
  • Fax: 718-339-3905
Mailing address:
  • Phone: 718-668-2601
  • Fax: 718-339-3905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number205728
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: