=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528047719
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYUDMILA VALDMAN MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 554 LARKFIELD RD STE 203
-----------------------------------------------------
City | EAST NORTHPORT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11731-4205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-266-6870
-----------------------------------------------------
Fax | 631-266-2548
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22 LUCILLE LN
-----------------------------------------------------
City | DIX HILLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11746-5810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-423-9883
-----------------------------------------------------
Fax | 631-423-9883
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 167985-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------