| Prokhorov's Pediatrics And Child Neurology Pc | |
|
9817 Queens Blvd Ll2 Rego Park NY 11374-3336 | |
| (718) 275-5600 | |
| (718) 275-5608 |
| Full Name | Prokhorov's Pediatrics And Child Neurology Pc |
|---|---|
| Speciality | Pediatrics |
| Location | 9817 Queens Blvd, Rego Park, New York |
| Authorized Official Name and Position | Svetlana Prokhorova (PRESIDENT) |
| Authorized Official Contact | 7189388762 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prokhorov's Pediatrics And Child Neurology Pc 9817 Queens Blvd Ll2 Rego Park NY 11374-3336 Ph: (718) 275-5600 | Prokhorov's Pediatrics And Child Neurology Pc 9817 Queens Blvd Ll2 Rego Park NY 11374-3336 Ph: (718) 275-5600 |
| NPI Number | 1104132778 |
|---|---|
| Provider Enumeration Date | 08/20/2010 |
| Last Update Date | 06/03/2011 |
| Medicare PECOS PAC ID | 3274701891 |
|---|---|
| Medicare Enrollment ID | O20110726000051 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104132778 | NPI | - | NPPES |
| Provider Name | Sergey Prokhorov |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1366419962 PECOS PAC ID: 3779503719 Enrollment ID: I20070629000093 |
| Provider Name | Svetlana Prokhorova |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1396754107 PECOS PAC ID: 5092983627 Enrollment ID: I20110726000546 |
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