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NPI Code Detail

MEDICARE: MIRIAM PAVLOVSKY RN, AGPCNP

MEDICARE:   MIRIAM  PAVLOVSKY  RN, AGPCNP
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
1163W00000XRegistered Nurse524614NY
2163WA2000XAdministrator Registered Nurse524614NY
3363LA2200XAdult Health Nurse Practitioner26NR17321500NJ
4363LA2200XAdult Health Nurse Practitioner308475NY
5363LG0600XGerontology Nurse Practitioner308475NY

General Provider Information

NPI Number : 1285158931
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIRIAM PAVLOVSKY RN, AGPCNP
Provider Business Mailing Address
First Line : 1001 MITCHEL FIELD WAY
Second Line :
City : GARDEN CITY
State : NY
Zip : 11530-5061
Country : US
Telephone Number : 347-204-5288
Fax Number :
Provider Business Practice Location Address
First Line : 1001 MITCHEL FIELD WAY
Second Line :
City : GARDEN CITY
State : NY
Zip : 11530-5061
Country : US
Telephone Number : 347-204-5288
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2017
Last Update Date : 07/21/2022

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