| Revived Soul Medical Pc | |
|
1901 Avenue P 1a Brooklyn NY 11229-1342 | |
| (718) 382-5060 | |
| Not Available |
| Full Name | Revived Soul Medical Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1901 Avenue P, Brooklyn, New York |
| Authorized Official Name and Position | Irina Kiblitsky (OWNER) |
| Authorized Official Contact | 7183825060 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revived Soul Medical Pc 1901 Avenue P 1a Brooklyn NY 11229-1342 Ph: (718) 382-5060 | Revived Soul Medical Pc 1901 Avenue P 1a Brooklyn NY 11229-1342 Ph: (718) 382-5060 |
| NPI Number | 1821389941 |
|---|---|
| Provider Enumeration Date | 04/23/2011 |
| Last Update Date | 04/23/2011 |
| Medicare PECOS PAC ID | 0749466266 |
|---|---|
| Medicare Enrollment ID | O20110518000539 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821389941 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 246958 (New York) | Primary |
| Provider Name | Edward Shalts |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1518035732 PECOS PAC ID: 1254389893 Enrollment ID: I20050110001030 |
| Provider Name | Irina Kiblitsky |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1215112719 PECOS PAC ID: 7012093107 Enrollment ID: I20080331000127 |
| Provider Name | Michael P Detres |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1861557530 PECOS PAC ID: 0547326340 Enrollment ID: I20090303000416 |
| Provider Name | Savely Meyerzon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1730357088 PECOS PAC ID: 7517014533 Enrollment ID: I20090409000066 |
| Provider Name | Michael Seropyan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386163053 PECOS PAC ID: 0143586495 Enrollment ID: I20171102002006 |
| Provider Name | Suzanne Elyse Bile |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265913024 PECOS PAC ID: 7719224674 Enrollment ID: I20190130002051 |
| Provider Name | Cacilda A Pinto |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528669934 PECOS PAC ID: 5193136083 Enrollment ID: I20201125000979 |
| Provider Name | Ellen Kudrow |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689054199 PECOS PAC ID: 6204112055 Enrollment ID: I20210125001374 |
| Provider Name | Tiffany Lauren Lawson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699350587 PECOS PAC ID: 4587063086 Enrollment ID: I20210603002490 |
| Provider Name | David Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851008544 PECOS PAC ID: 5698144830 Enrollment ID: I20221212000620 |
| Provider Name | Emily M Singer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982241238 PECOS PAC ID: 7113397977 Enrollment ID: I20230112001032 |
| Provider Name | Nataliya Pontone |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508147208 PECOS PAC ID: 3173994316 Enrollment ID: I20230125002292 |
| Provider Name | Irina Muchnik |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649656471 PECOS PAC ID: 6204293145 Enrollment ID: I20230607002696 |
| Provider Name | Svetlana Buryakov |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518339449 PECOS PAC ID: 7214395607 Enrollment ID: I20230616000260 |
| Provider Name | Carmen Wong |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134829302 PECOS PAC ID: 7618339771 Enrollment ID: I20230822001137 |
| Provider Name | Ekaterina Khaytsis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417422395 PECOS PAC ID: 9830631159 Enrollment ID: I20240603000125 |
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