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General NPI Number Information
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NPI Number | 1871775536
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Entity Type | Organization
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Legal Business Name | GOOD CARE PEDIATRIC LLP
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Dates
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Enumeration Date | 12/04/2007
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Last Update Date | 12/04/2007
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Provider Practice Location Address
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Address Line | 2647 CONEY ISLAND AVE
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City | BROOKLYN
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State | NY
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Zip | 11223-5502
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Country | US
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Telephone | 718-891-1551
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Fax | 718-368-1177
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Provider Business Mailing Address
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Address Line | 2647 CONEY ISLAND AVE
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City | BROOKLYN
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State | NY
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Zip | 11223-5502
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Country | US
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Telephone | 718-891-1551
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Fax | 718-368-1177
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Authorized Official
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Title or Position | DOCTOR
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Name | LILYA DAREVSKAYA
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Credential | DO
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Telephone | 718-891-1551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 208922
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License Number State | NY
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