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General NPI Number Information
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NPI Number | 1518655778
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Entity Type | Individual
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Provider Name | ANDRII SMOLNIKOV SA-C
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Gender | Male
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Dates
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Enumeration Date | 04/26/2023
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Last Update Date | 06/21/2025
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Provider Practice Location Address
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Address Line | 4545 CENTER BLVD APT LONG
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City | LONG ISLAND CITY
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State | NY
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Zip | 11109-5901
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Country | US
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Telephone | 171-875-3422
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Fax |
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Provider Business Mailing Address
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Address Line | 4545 CENTER BLVD APT LONG
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City | LONG ISLAND CITY
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State | NY
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Zip | 11109-5901
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Country | US
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Telephone | 718-753-4227
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Fax |
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 21-689
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | P133128
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License Number State | NY
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