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General NPI Number Information
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NPI Number | 1356634554
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Entity Type | Organization
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Legal Business Name | ADVANCED OB/GYN, PC
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Dates
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Enumeration Date | 05/20/2011
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Last Update Date | 02/08/2024
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Provider Practice Location Address
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Address Line | 1725 E 12TH ST #301
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City | BROOKLYN
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State | NY
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Zip | 11229-1028
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Country | US
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Telephone | 718-336-1909
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Fax | 718-336-1929
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Provider Business Mailing Address
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Address Line | 1725 E 12TH ST SUITE 301
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City | BROOKLYN
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State | NY
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Zip | 11229-1028
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Country | US
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Telephone | 718-336-1909
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Fax | 718-336-1929
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Authorized Official
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Title or Position | OWNER
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Name | DR. KAMILA AGAYAVA
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Credential | M.D.
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Telephone | 718-336-1909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 238834
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 226831
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License Number State | NY
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