MEDICARE: EVERCARE MEDICAL PC

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	207R00000X	Internal Medicine Physician	207506	NY

General Provider Information

NPI Number	:	1326299561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVERCARE MEDICAL PC

Provider Business Mailing Address
First Line	:	454 AVENUE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-4011
Country	:	US
Telephone Number	:	718-382-3400
Fax Number	:	718-382-3420

Provider Business Practice Location Address
First Line	:	454 AVENUE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-4011
Country	:	US
Telephone Number	:	718-382-3400
Fax Number	:	718-382-3420

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ALEKSANDRA RAYKHER
Credential	:	M.D.
Telephone Number	:	718-382-3400

Provider Enumeration Date	:	10/07/2008
Last Update Date	:	10/07/2008

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