Provider Demographics
NPI:1548920424
Name:LYUDMILA SVERKUNOVA MEDICAL P.C.
Entity type:Organization
Organization Name:LYUDMILA SVERKUNOVA MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYUDMILA
Authorized Official - Middle Name:
Authorized Official - Last Name:SVERKUNOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-645-0333
Mailing Address - Street 1:3280 NOSTRAND AVE APT L1A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3751
Mailing Address - Country:US
Mailing Address - Phone:718-645-0333
Mailing Address - Fax:
Practice Address - Street 1:3280 NOSTRAND AVE APT L1A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3751
Practice Address - Country:US
Practice Address - Phone:718-645-0333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-20
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02514854Medicaid