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General NPI Number Information
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NPI Number | 1164751863
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Entity Type | Individual
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Provider Name | ROSTISLAV DAVYDOV MD
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Gender | Male
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Dates
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Enumeration Date | 12/09/2009
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Last Update Date | 04/18/2013
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Provider Practice Location Address
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Address Line | 1386 FLATBUSH AVE
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City | BROOKLYN
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State | NY
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Zip | 11210-1353
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Country | US
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Telephone | 917-652-4020
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Fax | 917-652-4022
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Provider Business Mailing Address
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Address Line | 1781 E 17TH ST APT D1
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City | BROOKLYN
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State | NY
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Zip | 11229-2135
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Country | US
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Telephone | 917-733-8967
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 267811
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License Number State | NY
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