# PAVEL GOZENPUT MEDICAL PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790331080
- **Authorized official:** DR. PAVEL GOZENPUT MD (PRESIDENT)
- **Authorized official phone:** (718) 344-4474

## Contact information

- **Practice address:** 2083 E 65TH ST, BROOKLYN, NY 11234-5913
- **Practice address phone:** (718) 444-5105
- **Practice address fax:** (718) 444-5107
- **Mailing address:** 2083 E 65TH ST, BROOKLYN, NY 11234-5913
- **Mailing address phone:** (718) 444-5105
- **Mailing address fax:** (718) 444-5107

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/13/2019
- **Last updated:** 08/13/2019