Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 018222 | NY |
NPI | 1053719187 |
---|---|
Provider Name | Viktoriya Mirkin |
First Address | New York, NY 10065-4870 |
Second Address | New York, NY 10065-4870 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2014 |
Last Update Date | 01/11/2019 |