Provider Demographics
NPI:1972877967
Name:TELYATNIKOV, PAVEL (RPSGT)
Entity type:Individual
Prefix:
First Name:PAVEL
Middle Name:
Last Name:TELYATNIKOV
Suffix:
Gender:M
Credentials:RPSGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2792 OCEAN AVE
Mailing Address - Street 2:UNIT 5
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4729
Mailing Address - Country:US
Mailing Address - Phone:718-975-0640
Mailing Address - Fax:718-975-0639
Practice Address - Street 1:2792 OCEAN AVE
Practice Address - Street 2:UNIT 5
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4729
Practice Address - Country:US
Practice Address - Phone:718-975-0640
Practice Address - Fax:718-975-0639
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other