Healthcare Provider Details

I. General information

NPI: 1962895680
Provider Name (Legal Business Name): USA PROFESSIONAL MEDICAL SERVICES OF NEW YORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2015
Last Update Date: 03/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5920 MYRTLE AVE
RIDGEWOOD NY
11385-5658
US

IV. Provider business mailing address

4141 DUNDEE RD
NORTHBROOK IL
60062-2129
US

V. Phone/Fax

Practice location:
  • Phone: 718-504-6364
  • Fax: 224-246-8042
Mailing address:
  • Phone: 847-257-1244
  • Fax: 224-246-8042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: YAN KATSNELSON
Title or Position: DIRECTOR
Credential: MD
Phone: 847-257-1244