1477514644 NPI number — MR. OLEG A VISHNYAK PAC

Table of content: MR. OLEG A VISHNYAK PAC (NPI 1477514644)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477514644 NPI number — MR. OLEG A VISHNYAK PAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VISHNYAK
Provider First Name:
OLEG
Provider Middle Name:
A
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PAC
Provider Gender Code:
M

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:
1477514644
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1915 SEAGIRT BLVD
Provider Second Line Business Mailing Address:
APT 12F
Provider Business Mailing Address City Name:
FAR ROCKWAY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11691
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-471-7833
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
270-05 76TH AVE
Provider Second Line Business Practice Location Address:
SUITE 0-4000
Provider Business Practice Location Address City Name:
NEW HYDE PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-470-7460
Provider Business Practice Location Address Fax Number:
718-343-1438
Provider Enumeration Date:
03/29/2006

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: 363A00000X , with the licence number:  010656 , 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)





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