Healthcare Provider Details

I. General information

NPI: 1376901298
Provider Name (Legal Business Name): VAMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2016
Last Update Date: 02/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E 34TH ST APT 8D
NEW YORK NY
10016-5209
US

IV. Provider business mailing address

300 E 34TH ST APT 8D
NEW YORK NY
10016-5209
US

V. Phone/Fax

Practice location:
  • Phone: 646-404-0710
  • Fax:
Mailing address:
  • Phone: 646-404-0710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number340371
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number340371
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number340371
License Number StateNY

VIII. Authorized Official

Name: MARCEL KAGANOVSKAYA
Title or Position: NURSE PRACTITIONER
Credential:
Phone: 646-404-0710