MEDICARE: IGOR CHERNYAVSKIY 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	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	214470	NY
2	207RP1001X	Pulmonary Disease Physician	214470	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	:	1477520245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IGOR CHERNYAVSKIY M.D.

Provider Business Mailing Address
First Line	:	16 TALLOW LN
Second Line	:
City	:	LAKE GROVE
State	:	NY
Zip	:	11755-1806
Country	:	US
Telephone Number	:	631-261-4400
Fax Number	:

Provider Business Practice Location Address
First Line	:	2625 E 14TH ST
Second Line	:	SUITE 201
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3973
Country	:	US
Telephone Number	:	718-891-7800
Fax Number	:	718-332-7246

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

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	10/31/2007

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