Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | 221613 | NY |
NPI | 1245231232 |
---|---|
Provider Name | Dr. Dmitriy Vaysman |
First Address | Babylon, NY 11702-1314 |
Second Address | Babylon, NY 11702-1314 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2005 |
Last Update Date | 29/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02753455 | (05) | NY |
I18744 | (02) | NY |