MEDICARE: IVONNE DABOVICH C.M.

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	176B00000X	Midwife	F001016	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164499760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVONNE DABOVICH C.M.

Provider Business Mailing Address
First Line	:	8900 VAN WYCK EXPY
Second Line	:	DEPT OB/GYN
City	:	JAMAICA
State	:	NY
Zip	:	11418-2832
Country	:	US
Telephone Number	:	718-206-6808
Fax Number	:

Provider Business Practice Location Address
First Line	:	8900 VAN WYCK EXPY
Second Line	:	DEPT OB/GYN
City	:	JAMAICA
State	:	NY
Zip	:	11418-2832
Country	:	US
Telephone Number	:	718-206-6808
Fax Number	:

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

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	08/18/2010

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