Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 15973-1 | NY |
NPI | 1093891277 |
---|---|
Provider Name | Dr. Viktor B Smirnov |
First Address | East Meadow, NY 11554 |
Second Address | Mineola, NY 11501-4112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 02/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00972743 | (05) | NY |
A64317 | (02) |