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NPI Code Detail

MEDICARE: DOCTOR OF MEDICINE IN THE HOUSE, P.C.

MEDICARE: DOCTOR OF MEDICINE IN THE HOUSE, P.C.
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
1173000000XLegal Medicine

General Provider Information

NPI Number : 1396780961
Entity Type Code : Organization
Provider Name (Legal Business Name) : DOCTOR OF MEDICINE IN THE HOUSE, P.C.
Provider Business Mailing Address
First Line : 3849 NOSTRAND AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11235-2012
Country : US
Telephone Number : 718-368-9555
Fax Number : 718-648-3849
Provider Business Practice Location Address
First Line : 3849 NOSTRAND AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11235-2012
Country : US
Telephone Number : 718-368-9555
Fax Number : 718-648-3849
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : DR. PAVEL YUTSIS
Credential : M.D.
Telephone Number : 718-368-9555
Provider Enumeration Date : 06/18/2006
Last Update Date : 11/15/2007

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