MEDICARE: DR. YEVGENY PISAREVSKY DDS

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	122300000X	Dentist	046086	NY

General Provider Information

NPI Number	:	1720497670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YEVGENY PISAREVSKY DDS

Provider Business Mailing Address
First Line	:	907 SAINT MARKS AVE
Second Line	:	2ND FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11213-2004
Country	:	US
Telephone Number	:	718-778-3283
Fax Number	:	718-778-3284

Provider Business Practice Location Address
First Line	:	907 SAINT MARKS AVE
Second Line	:	2ND FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11213-2004
Country	:	US
Telephone Number	:	718-778-3283
Fax Number	:	718-778-3284

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

Provider Enumeration Date	:	08/05/2014
Last Update Date	:	08/05/2014

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