MEDICARE: MR. IGOR RYVKIN RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	597970	NY

General Provider Information

NPI Number	:	1154667749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. IGOR RYVKIN RN

Provider Business Mailing Address
First Line	:	1485 E 22ND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-5122
Country	:	US
Telephone Number	:	646-591-7394
Fax Number	:

Provider Business Practice Location Address
First Line	:	1485 E 22ND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-5122
Country	:	US
Telephone Number	:	646-591-7394
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/31/2012
Last Update Date	:	12/31/2012

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