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General NPI Number Information
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NPI Number | 1376411249
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Entity Type | Organization
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Legal Business Name | AHAVA MEDICAL CARE P.L.L.C.
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Dates
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Enumeration Date | 10/23/2025
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Last Update Date | 11/17/2025
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Provider Practice Location Address
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Address Line | 1659 RALPH AVE
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City | BROOKLYN
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State | NY
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Zip | 11236-3381
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Country | US
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Telephone | 718-255-9955
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Fax |
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Provider Business Mailing Address
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Address Line | 1659 RALPH AVE
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City | BROOKLYN
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State | NY
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Zip | 11236-3381
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Country | US
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Telephone | 718-255-9955
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ILYA TARASCIN
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Credential | DO
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Telephone | 516-616-8629
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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 |
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License Number State |
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