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General NPI Number Information
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NPI Number | 1457311987
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Entity Type | Individual
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Provider Name | LUDMILA DAVIDOV
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Gender | Female
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Dates
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Enumeration Date | 03/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9745 QUEENS BLVD
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City | REGO PARK
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State | NY
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Zip | 11374-2101
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Country | US
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Telephone | 718-459-0500
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Fax | 718-997-6817
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Provider Business Mailing Address
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Address Line | 9850 63RD DR APT# 5G
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City | REGO PARK
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State | NY
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Zip | 11374-2337
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Country | US
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Telephone | 718-275-7485
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Fax | 718-997-6817
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 221669
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License Number State | NY
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