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General NPI Number Information
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NPI Number | 1972741023
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Entity Type | Individual
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Provider Name | VLADISLAV KUZNETSOV PA
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Gender | Male
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Dates
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Enumeration Date | 01/28/2009
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 30 RIDGE LOOP
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City | STATEN ISLAND
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State | NY
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Zip | 10304-1403
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Country | US
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Telephone | 917-836-7374
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Fax | 718-865-4255
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Provider Business Mailing Address
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Address Line | 30 RIDGE LOOP
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City | STATEN ISLAND
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State | NY
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Zip | 10304-1403
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Country | US
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Telephone | 917-836-7374
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Fax | 718-865-4255
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 007745
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License Number State | NY
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