=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407158348
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | G VAISMAN INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2010
-----------------------------------------------------
Last Update Date | 12/08/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2299 POST ST SUITE 201
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94115-3441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-346-7008
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2299 POST ST SUITE 201
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94115-3441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-346-7008
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. GREGORY I VAISMAN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 415-346-7008
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | A37005
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------