| Izabella Dyakovetsky MD, LLC | |
|
201 Lakeside Park Ste B Southampton PA 18966-4049 | |
| (215) 322-9020 | |
| (215) 322-9040 |
| Full Name | Izabella Dyakovetsky MD, LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 201 Lakeside Park, Southampton, Pennsylvania |
| Authorized Official Name and Position | Izabella Dyakovetsky (PRESEDENT) |
| Authorized Official Contact | 2153229020 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Izabella Dyakovetsky MD, LLC 201 Lakeside Park Ste B Southampton PA 18966-4049 Ph: (215) 322-9020 | Izabella Dyakovetsky MD, LLC 201 Lakeside Park Ste B Southampton PA 18966-4049 Ph: (215) 322-9020 |
| NPI Number | 1932360559 |
|---|---|
| Provider Enumeration Date | 06/17/2008 |
| Last Update Date | 06/17/2008 |
| Medicare PECOS PAC ID | 0547323149 |
|---|---|
| Medicare Enrollment ID | O20090108000059 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932360559 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (NU) | Primary |
| Provider Name | Izabella L Dyakovetsky |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1073512927 PECOS PAC ID: 5193888790 Enrollment ID: I20090108000041 |
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