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General NPI Number Information
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NPI Number | 1942465091
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Entity Type | Organization
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Legal Business Name | LARISA VEKSMAN D.O P.C
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Dates
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Enumeration Date | 07/28/2008
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Last Update Date | 07/28/2008
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Provider Practice Location Address
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Address Line | 162 BRIGHTON 11TH ST 1ST FLOOR
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City | BROOKLYN
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State | NY
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Zip | 11235-5327
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Country | US
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Telephone | 718-891-8822
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Fax | 718-891-8823
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Provider Business Mailing Address
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Address Line | 21 GOODALL ST
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City | STATEN ISLAND
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State | NY
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Zip | 10308-3325
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Country | US
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Telephone | 718-891-8822
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Fax | 718-891-8823
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Authorized Official
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Title or Position | OWNER
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Name | LARISA VEKSMAN
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Credential | D.O
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Telephone | 718-891-8822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 223381
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License Number State | NY
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