Individual
DR. IVGENIJA FASTOVSKY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
19111 COLLINS AVE APT 2505, SUNNY ISLES BEACH, FL 33160-2384
(305) 933-6873
(305) 933-6873
Mailing address
19111 COLLINS AVE APT 2505, SUNNY ISLES BEACH, FL 33160-2384
(305) 933-6873
(305) 933-6873
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
ME 59109
FL
2084P0805X
Geriatric Psychiatry Physician
Primary
ME 59109
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00580525
—
NY
01
—
P 55311
MEDICARE GHI
NY
Enumeration date
12/10/2008
Last updated
12/10/2008
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