MEDICARE: GALINA VENIKOVA MD

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	238461	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	:	1659346815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GALINA VENIKOVA MD

Provider Business Mailing Address
First Line	:	2220 AVE U
Second Line	:	APT.#1
City	:	BROOKLYN
State	:	NY
Zip	:	11229-3648
Country	:	US
Telephone Number	:	718-934-7081
Fax Number	:

Provider Business Practice Location Address
First Line	:	1009 BRIGHTON BEACH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-5659
Country	:	US
Telephone Number	:	718-975-8500
Fax Number	:	718-975-8502

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

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	12/08/2017

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