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General NPI Number Information
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NPI Number | 1427190800
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Entity Type | Organization
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Legal Business Name | GRAVESEND MEDICAL SERVICES,P.C.
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 825 AVENUE W
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City | BROOKLYN
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State | NY
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Zip | 11223-5558
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Country | US
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Telephone | 718-336-1810
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Fax | 718-627-9338
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Provider Business Mailing Address
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Address Line | 825 AVENUE W
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City | BROOKLYN
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State | NY
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Zip | 11223-5558
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Country | US
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Telephone | 718-336-1810
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Fax | 718-627-9338
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. YELENA ILINA
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Credential | M.D.
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Telephone | 718-336-1810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 1974471
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License Number State | NY
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