Provider Demographics
NPI:1487174546
Name:MOGILEVSKAYA, LYUDMILA
Entity type:Individual
Prefix:MRS
First Name:LYUDMILA
Middle Name:
Last Name:MOGILEVSKAYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1877 E 12TH ST APT 5A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2718
Mailing Address - Country:US
Mailing Address - Phone:347-850-5400
Mailing Address - Fax:
Practice Address - Street 1:1877 E 12TH ST APT 5A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2718
Practice Address - Country:US
Practice Address - Phone:347-850-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF305531-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner