Provider Demographics
NPI:1184503088
Name:VALENTIN AVANESSOV PHYSICIAN PC
Entity type:Organization
Organization Name:VALENTIN AVANESSOV PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VALENTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AVANESSOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-891-7100
Mailing Address - Street 1:3059 BRIGHTON 13TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5607
Mailing Address - Country:US
Mailing Address - Phone:718-891-7100
Mailing Address - Fax:718-891-3834
Practice Address - Street 1:3059 BRIGHTON 13TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5607
Practice Address - Country:US
Practice Address - Phone:718-891-7100
Practice Address - Fax:718-891-3834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty