Provider Demographics
NPI:1871513432
Name:LITVAK, YEVGENY (MD)
Entity type:Individual
Prefix:
First Name:YEVGENY
Middle Name:
Last Name:LITVAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 W 5TH ST
Mailing Address - Street 2:SUITE M1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-4071
Mailing Address - Country:US
Mailing Address - Phone:718-234-2233
Mailing Address - Fax:718-234-2227
Practice Address - Street 1:1460 W 5TH ST
Practice Address - Street 2:SUITE M1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-4071
Practice Address - Country:US
Practice Address - Phone:718-234-2233
Practice Address - Fax:718-234-2227
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199897207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01909397Medicaid
NY01909397Medicaid
NY37N552Medicare ID - Type Unspecified