NPIMap

Organization Active NPI

Good Care Pediatric LLP

  • Pediatrics Physician
  • Brooklyn, NY
National Provider Identifier
1871775536
Registry record updated Dec 4, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
208922 Issued in NY
Legal business name
GOOD CARE PEDIATRIC LLP
Practice address
2647 Coney Island Ave
Brooklyn, NY 11223-5502
Phone
(718) 891-1551
Fax
(718) 368-1177
NPI assigned
Dec 4, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lilya Darevskaya, DO
Title
Doctor
Phone
(718) 891-1551

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X 208922 NY Primary

Addresses

Primary practice location

2647 Coney Island Ave
Brooklyn, NY 11223-5502

Mailing address

2647 Coney Island Ave
Brooklyn, NY 11223-5502
Phone (718) 891-1551

Other identifiers 1

IdentifierTypeStateIssuer
01884293MedicaidNY

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196726400000",
    "number": "1871775536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2647 CONEY ISLAND AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112235502",
            "telephone_number": "718-891-1551",
            "fax_number": "718-368-1177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2647 CONEY ISLAND AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112235502",
            "telephone_number": "718-891-1551",
            "fax_number": "718-368-1177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD CARE PEDIATRIC LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-04",
        "last_updated": "2007-12-04",
        "status": "A",
        "authorized_official_last_name": "DAREVSKAYA",
        "authorized_official_first_name": "LILYA",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "718-891-1551",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "208922",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01884293",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.