MEDICARE: DR. NATALIYA KRIVITSKAYA 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	208000000X	Pediatrics Physician	051255	CT
2	208000000X	Pediatrics Physician	267198	NY

General Provider Information

NPI Number	:	1740539931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATALIYA KRIVITSKAYA M.D.

Provider Business Mailing Address
First Line	:	627 LYDIG AVE
Second Line	:	1 FL
City	:	BRONX
State	:	NY
Zip	:	10462-2283
Country	:	US
Telephone Number	:	718-772-0070
Fax Number	:

Provider Business Practice Location Address
First Line	:	627 LYDIG AVE
Second Line	:	1 FL
City	:	BRONX
State	:	NY
Zip	:	10462-2283
Country	:	US
Telephone Number	:	718-772-0070
Fax Number	:

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

Provider Enumeration Date	:	09/03/2012
Last Update Date	:	10/21/2013

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