MEDICARE: IS TOTAL 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1588715668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IS TOTAL MEDICAL PC

Provider Business Mailing Address
First Line	:	1009 BRIGHTON BEACH AVE
Second Line	:	STE 1A
City	:	BROOKLYN
State	:	NY
Zip	:	11235-5606
Country	:	US
Telephone Number	:	718-332-3200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1009 BRIGHTON BEACH AVE
Second Line	:	STE 1A
City	:	BROOKLYN
State	:	NY
Zip	:	11235-5606
Country	:	US
Telephone Number	:	718-332-3200
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PAVEL YUTSIS
Credential	:	MD
Telephone Number	:	718-332-3200

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	08/22/2020

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