Healthcare Provider Details

I. General information

NPI: 1033930144
Provider Name (Legal Business Name): NATALIA MEZEROVSKY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NATALIA ABRAMOV VASILIEVA NP

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 OCEAN PKWY
BROOKLYN NY
11235-7745
US

IV. Provider business mailing address

42 GOTHAM AVE
BROOKLYN NY
11229-6012
US

V. Phone/Fax

Practice location:
  • Phone: 347-409-5087
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number409158
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number350228
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: