Healthcare Provider Details

I. General information

NPI: 1366697476
Provider Name (Legal Business Name): ANATOLY BELILOVSKY MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 11/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 BAY ST
STATEN ISLAND NY
10304-3830
US

IV. Provider business mailing address

690 BAY ST
STATEN ISLAND NY
10304-3830
US

V. Phone/Fax

Practice location:
  • Phone: 718-815-7050
  • Fax: 718-815-4889
Mailing address:
  • Phone: 718-815-7050
  • Fax: 718-815-4889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number176593
License Number StateNY

VIII. Authorized Official

Name: DR. ANATOLY BELILOVSKY
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 718-815-7050