Provider Demographics
NPI:1174624944
Name:MS VAISMAN MEDICAL SERVICES A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MS VAISMAN MEDICAL SERVICES A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:VAISMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-506-6937
Mailing Address - Street 1:11724 VENTURA BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604
Mailing Address - Country:US
Mailing Address - Phone:818-506-6937
Mailing Address - Fax:818-506-2594
Practice Address - Street 1:11724 VENTURA BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604
Practice Address - Country:US
Practice Address - Phone:818-506-6937
Practice Address - Fax:818-506-2594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38899207Q00000X, 208D00000X
2085N0700X, 2085R0202X, 2085R0204X, 2085U0001X, 208600000X, 225100000X, 2278P1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2278P1004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPulmonary DiagnosticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA206140013OtherPACIFICARE PREMIER HMO
CA2840525OtherAETNA HMO
CA146780057OtherPACIFICARE NIPA HMO
CA24013OtherUHP
CA3709552008OtherCIGNA PREMIER HMO
CA146970061OtherPACIFICARE ST VINCENT
CA4341338OtherAETNA PPO
CA124100111OtherPACIFICARE REGAL HMO
CA19190OtherCARE 1ST HEALTH PLAN NOBL
CA3709552OtherCIGNA PPO
CA00A388990OtherBLUE SHIELD
CA00A388990Medicaid
CA047692OtherHEALTH NET
CADK033OtherUNIVERSAL CARE
CA146780057OtherPACIFICARE NIPA HMO
CA=========OtherPACIFICARE PPO
CA00A388990Medicaid
CA146780057OtherPACIFICARE NIPA HMO
A28755Medicare UPIN