Provider Demographics
NPI:1043455686
Name:LITVINOVA MEDICAL PC
Entity type:Organization
Organization Name:LITVINOVA MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:LITVINOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-202-2968
Mailing Address - Street 1:110 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-2787
Mailing Address - Country:US
Mailing Address - Phone:646-202-2968
Mailing Address - Fax:718-857-8415
Practice Address - Street 1:110 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-2787
Practice Address - Country:US
Practice Address - Phone:646-202-2968
Practice Address - Fax:718-857-8415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-11
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219127261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care