Provider Demographics
NPI:1003843061
Name:VEKSMAN, LARISA (MD)
Entity Type:Individual
Prefix:
First Name:LARISA
Middle Name:
Last Name:VEKSMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 BRIGHTON 11TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5327
Mailing Address - Country:US
Mailing Address - Phone:718-891-8822
Mailing Address - Fax:646-349-2066
Practice Address - Street 1:162 BRIGHTON 11STREET
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235
Practice Address - Country:US
Practice Address - Phone:212-686-6700
Practice Address - Fax:646-349-2066
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22338-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02255787Medicaid
NY270067821Other1199NBF
NY0102248OtherAMERICHOICE
NY5558DOtherEMPIRE BCBSH
NY7888447OtherAETNA PPO
NY270067821OtherMAGNACARE
NY9400588OtherPHCS
NY3C5041OtherHEALTHNET
NY8990102OtherCIGNA
NYP3245014OtherOXFORD
NY2373089OtherUNATED HEALTH CARE
NY270067821OtherMULTIPLAN
NY214676POtherHIP
NY5996861OtherGHI