MEDICARE: VALLEY STREAM DIAGNOSTIC MEDICINE 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
1	2084P0800X	Psychiatry Physician	209601	NY

General Provider Information

NPI Number	:	1578944492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY STREAM DIAGNOSTIC MEDICINE P.C.

Provider Business Mailing Address
First Line	:	501 BRIGHTON BEACH AVE
Second Line	:	2
City	:	BROOKLYN
State	:	NY
Zip	:	11235-6403
Country	:	US
Telephone Number	:	718-942-5686
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 BRIGHTON BEACH AVE
Second Line	:	2
City	:	BROOKLYN
State	:	NY
Zip	:	11235-6403
Country	:	US
Telephone Number	:	718-942-5686
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALEKSANDR LEVIN
Credential	:	M.D.
Telephone Number	:	718-942-5686

Provider Enumeration Date	:	06/16/2015
Last Update Date	:	06/16/2015

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