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NPI Code Detail

MEDICARE: DARIA VASILYEVA DDS

MEDICARE: DARIA VASILYEVA DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223P0106XOral and Maxillofacial Pathology Dentistry062977NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1390200000XOTHERN/A

General Provider Information

NPI Number : 1396301503
Entity Type Code : Individual
Provider Name (Legal Business Name) : DARIA VASILYEVA DDS
Provider Business Mailing Address
First Line : 630 W 168TH ST PH 15-1562
Second Line :
City : NEW YORK
State : NY
Zip : 10032-3725
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 630 W 168TH ST
Second Line :
City : NEW YORK
State : NY
Zip : 10032-3725
Country : US
Telephone Number : 212-305-4552
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2019
Last Update Date : 01/02/2024

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