Provider Demographics
NPI:1447440029
Name:IDELEVITCH, NATHALIA (MD)
Entity type:Individual
Prefix:
First Name:NATHALIA
Middle Name:
Last Name:IDELEVITCH
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3048 BRIGHTON 1ST ST STE 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-8081
Mailing Address - Country:US
Mailing Address - Phone:347-702-9531
Mailing Address - Fax:347-713-6416
Practice Address - Street 1:3048 BRIGHTON 1ST ST STE 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8081
Practice Address - Country:US
Practice Address - Phone:347-702-9531
Practice Address - Fax:347-713-6416
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD451234207QG0300X
NY244585207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine