MEDICARE: DR. LEONID GORELIK M.D.

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	207V00000X	Obstetrics & Gynecology Physician	228959	NY

General Provider Information

NPI Number	:	1467536839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEONID GORELIK M.D.

Provider Business Mailing Address
First Line	:	5724 NEW UTRECHT AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-4633
Country	:	US
Telephone Number	:	718-436-0100
Fax Number	:	718-436-1563

Provider Business Practice Location Address
First Line	:	5724 NEW UTRECHT AVENUE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219
Country	:	US
Telephone Number	:	718-436-0100
Fax Number	:	718-436-1563

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	09/28/2009

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