Individual
IVAN JAVAKHISHVILI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2955 NOSTRAND AVE, BROOKLYN, NY 11229-1873
(917) 833-2391
Mailing address
2955 NOSTRAND AVE, BROOKLYN, NY 11229-1873
(917) 833-2391
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
2106612-DCA
NY
Other
Enumeration date
04/09/2025
Last updated
04/09/2025
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