MEDICARE: DR. ROBERT ELLEK LADYZHENSKY D.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	111N00000X	Chiropractor	CH 10724	FL
2	111N00000X	Chiropractor	70012246	NY

General Provider Information

NPI Number	:	1891043733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT ELLEK LADYZHENSKY D.C.

Provider Business Mailing Address
First Line	:	140 87TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-4916
Country	:	US
Telephone Number	:	941-447-9458
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 87TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-4916
Country	:	US
Telephone Number	:	941-447-9458
Fax Number	:

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

Provider Enumeration Date	:	08/27/2012
Last Update Date	:	10/12/2012

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