=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184971624
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | V P S MEDICAL PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2012
-----------------------------------------------------
Last Update Date | 02/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 791 PARK AVE APT 1B
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021-3512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-951-1877
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 791 PARK AVE APT 1B
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021-3512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-951-1877
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | ALEKSANDR SHTEYNBERG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 212-951-1877
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number | 248881
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------