Individual ProviderNicholas PavlovSpeech-Language PathologistSpeech, Language and Hearing Service ProvidersPractice Address383 State St, Brooklyn, NY 11217-1706(718) 852-1701(917) 865-0650PECOS EnrollmentBased on the most recent information from CMS, provider Nicholas Pavlov does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 6 days ago.Profile DetailsProvider ID1336682814Provider TypeIndividualFull NamePavlov, NicholasTitleMr.GenderMaleSole ProprietorYesEnumeration Date12/1/2016Last Updated12/1/2016Contact InformationPractice LocationPractice Address383 State St, Brooklyn, NY 11217-1706Phone(718) 852-1701FaxUnlisted FaxMailing LocationMailing Address383 State St, Brooklyn, NY 11217-1706Phone(917) 865-0650FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode235Z00000XPrimaryDescriptionSpeech-Language PathologistSpeech, Language and Hearing Service ProvidersLicense024508-1New York