1861607897 NPI number — MS. VIKTORIA A HODYNSKY C.M.M.T, C.M.T

Table of content: MS. VIKTORIA A HODYNSKY C.M.M.T, C.M.T (NPI 1861607897)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861607897 NPI number — MS. VIKTORIA A HODYNSKY C.M.M.T, C.M.T

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HODYNSKY
Provider First Name:
VIKTORIA
Provider Middle Name:
A
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
C.M.M.T, C.M.T
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ATAMASHKO
Provider Other First Name:
VIKTORIA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1861607897
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2808 SILVER LN NE
Provider Second Line Business Mailing Address:
#308
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55421-3468
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-781-0229
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1310 HIGHWAY 96 E
Provider Second Line Business Practice Location Address:
#214
Provider Business Practice Location Address City Name:
WHITE BEAR LAKE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55110-3624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-429-0706
Provider Business Practice Location Address Fax Number:
612-788-4065
Provider Enumeration Date:
05/12/2007

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: 225700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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