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General NPI Number Information
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NPI Number | 1558599381
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Entity Type | Individual
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Provider Name | PAVEL GOZENPUT M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/01/2009
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 1 HEALTHY WAY
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City | OCEANSIDE
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State | NY
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Zip | 11572
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Country | US
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Telephone | 516-632-3200
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Fax |
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Provider Business Mailing Address
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Address Line | 247 WHITMAN DR
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City | BROOKLYN
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State | NY
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Zip | 11234-6934
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Country | US
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Telephone | 718-344-4474
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Fax |
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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 | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 265898
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | 265898
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 265898
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License Number State | NY
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