Provider Demographics
NPI:1871775536
Name:GOOD CARE PEDIATRIC LLP
Entity type:Organization
Organization Name:GOOD CARE PEDIATRIC LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:LILYA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAREVSKAYA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-891-1551
Mailing Address - Street 1:2647 CONEY ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-5502
Mailing Address - Country:US
Mailing Address - Phone:718-891-1551
Mailing Address - Fax:718-368-1177
Practice Address - Street 1:2647 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-5502
Practice Address - Country:US
Practice Address - Phone:718-891-1551
Practice Address - Fax:718-368-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208922208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01884293Medicaid