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General NPI Number Information
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NPI Number | 1093891277
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Entity Type | Individual
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Provider Name | VIKTOR B SMIRNOV MD
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Gender | Male
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 05/03/2023
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Provider Practice Location Address
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Address Line | 300 OLD COUNTRY RD STE 101
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City | MINEOLA
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State | NY
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Zip | 11501-4112
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Country | US
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Telephone | 516-741-4138
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Fax |
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Provider Business Mailing Address
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Address Line | 30 MERRICK AVE
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City | EAST MEADOW
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State | NY
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Zip | 11554
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Country | US
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Telephone | 516-794-0444
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Fax | 516-542-0414
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 15973
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 15973-1
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License Number State | NY
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