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General NPI Number Information
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NPI Number | 1184742835
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Entity Type | Organization
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Legal Business Name | L.DAREVSKAYA PEDIATRIC CENTER
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7819 19TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11214-1203
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Country | US
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Telephone | 718-236-7550
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Fax |
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Provider Business Mailing Address
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Address Line | 7819 19TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11214-1203
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Country | US
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Telephone | 718-236-7550
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. LILYA DAREVSKAYA
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Credential | D.O.
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Telephone | 718-236-7550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 208922
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License Number State | NY
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