Provider Demographics
NPI:1578854980
Name:LARISA N. LIKVER, MEDICAL P.C.
Entity type:Organization
Organization Name:LARISA N. LIKVER, MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARISA
Authorized Official - Middle Name:N
Authorized Official - Last Name:LIKVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-259-0199
Mailing Address - Street 1:181 COLERIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4130
Mailing Address - Country:US
Mailing Address - Phone:917-951-6426
Mailing Address - Fax:718-256-0109
Practice Address - Street 1:8419 BAY PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-3303
Practice Address - Country:US
Practice Address - Phone:718-259-0199
Practice Address - Fax:718-256-0109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-20
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216637208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty