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General NPI Number Information
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NPI Number | 1275783789
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Entity Type | Organization
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Legal Business Name | PARAMOUNT ANESTHESIA PRACTICE PC
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Dates
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Enumeration Date | 09/22/2008
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Last Update Date | 11/12/2014
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Provider Practice Location Address
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Address Line | 1773 E 19TH ST # 1C
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City | BROOKLYN
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State | NY
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Zip | 11229-2245
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Country | US
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Telephone | 914-886-8403
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Fax | 347-254-6676
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Provider Business Mailing Address
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Address Line | 105 KINGS HWY APT 4B
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City | BROOKLYN
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State | NY
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Zip | 11214-1562
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Country | US
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Telephone | 914-886-8403
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Fax | 347-254-6676
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK KOVALEVSKIY
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Credential | M.D.
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Telephone | 914-886-8403
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 233344
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License Number State | NY
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