Healthcare Provider Details

I. General information

NPI: 1174809438
Provider Name (Legal Business Name): V V MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2011
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 AVENUE T SUITE 1
BROOKLYN NY
11223-3402
US

IV. Provider business mailing address

45 AVENUE T SUITE 1
BROOKLYN NY
11223-3402
US

V. Phone/Fax

Practice location:
  • Phone: 347-462-2559
  • Fax:
Mailing address:
  • Phone: 347-462-2559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number258938
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number258938
License Number StateNY

VIII. Authorized Official

Name: VALERIYA VAYNSHTEYN
Title or Position: PRESIDENT
Credential: MD
Phone: 347-462-2559