=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952781650
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VAISMAN MEDICAL SERVICES PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2015
-----------------------------------------------------
Last Update Date | 06/08/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5685 BUENA MARTINA WAY
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89141-7104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-608-8650
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5685 BUENA MARTINA WAY
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89141-7104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-608-8650
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | ALEX VAISMAN
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 917-608-8650
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | DO1374
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------