| Lindenwood Medical Pc | |
|
11 Ralph Pl Ste 112 Staten Island NY 10304-4408 | |
| (718) 954-2202 | |
| Not Available |
| Full Name | Lindenwood Medical Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 11 Ralph Pl Ste 112, Staten Island, New York |
| Authorized Official Name and Position | Zoya Koroleva (MEDICAL DIRECTOR) |
| Authorized Official Contact | 7189542202 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lindenwood Medical Pc 11 Ralph Pl Ste 112 Staten Island NY 10304-4408 Ph: (718) 954-2202 | Lindenwood Medical Pc 11 Ralph Pl Ste 112 Staten Island NY 10304-4408 Ph: (718) 954-2202 |
| NPI Number | 1811220882 |
|---|---|
| Provider Enumeration Date | 09/09/2009 |
| Last Update Date | 01/04/2022 |
| Medicare PECOS PAC ID | 5193861763 |
|---|---|
| Medicare Enrollment ID | O20091013000209 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811220882 | NPI | - | NPPES |
| 03130027 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | 251641 (New York) | Primary |
| Provider Name | Zoya Koroleva |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588823025 PECOS PAC ID: 9931245503 Enrollment ID: I20091013000202 |
| Provider Name | Stanislav Kaminyar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1235360470 PECOS PAC ID: 9234365404 Enrollment ID: I20131118000125 |
| Provider Name | Svetlana Veltman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023568912 PECOS PAC ID: 0042596777 Enrollment ID: I20180126002462 |
| Provider Name | Juliana Tacardon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376964452 PECOS PAC ID: 3870827983 Enrollment ID: I20190624002627 |
| Provider Name | Natalia Maximovsky |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265990097 PECOS PAC ID: 1052646494 Enrollment ID: I20190708002709 |
| Provider Name | Julia Kay |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548899198 PECOS PAC ID: 4082039987 Enrollment ID: I20200810002375 |
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