MEDICARE: SEABREEZE MEDICAL, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	200156	NY

General Provider Information

NPI Number	:	1275781403
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEABREEZE MEDICAL, PC

Provider Business Mailing Address
First Line	:	135 SEA BREEZE AVE
Second Line	:	SUITE 101
City	:	BROOKLYN
State	:	NY
Zip	:	11224-3701
Country	:	US
Telephone Number	:	718-338-0300
Fax Number	:	718-513-0424

Provider Business Practice Location Address
First Line	:	135 SEA BREEZE AVE
Second Line	:	SUITE 101
City	:	BROOKLYN
State	:	NY
Zip	:	11224-3701
Country	:	US
Telephone Number	:	718-338-0300
Fax Number	:	718-513-0424

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	VLADIMIR K. SMIRNOV
Credential	:	M.D.
Telephone Number	:	718-338-0300

Provider Enumeration Date	:	08/29/2008
Last Update Date	:	08/29/2008

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