Provider Demographics
NPI:1396780961
Name:DOCTOR OF MEDICINE IN THE HOUSE, P.C.
Entity type:Organization
Organization Name:DOCTOR OF MEDICINE IN THE HOUSE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAVEL
Authorized Official - Middle Name:
Authorized Official - Last Name:YUTSIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-368-9555
Mailing Address - Street 1:3849 NOSTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2012
Mailing Address - Country:US
Mailing Address - Phone:718-368-9555
Mailing Address - Fax:718-648-3849
Practice Address - Street 1:3849 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2012
Practice Address - Country:US
Practice Address - Phone:718-368-9555
Practice Address - Fax:718-648-3849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW2T5T1Medicare PIN