1457557514 NPI number — SVETLANA TROUNINA M.D.,

Table of content: SVETLANA TROUNINA M.D., (NPI 1457557514)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457557514 NPI number — SVETLANA TROUNINA M.D.,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TROUNINA
Provider First Name:
SVETLANA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.,
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457557514
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
241 PARRISH ST
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
CANANDAIGUA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14424-1784
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-387-5149
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
241 PARRISH ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
CANANDAIGUA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14424-1784
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-394-1300
Provider Business Practice Location Address Fax Number:
585-394-1305
Provider Enumeration Date:
06/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  241242 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02924936 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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