Provider Demographics
NPI:1275781403
Name:SEABREEZE MEDICAL, PC
Entity Type:Organization
Organization Name:SEABREEZE MEDICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VLADIMIR
Authorized Official - Middle Name:K
Authorized Official - Last Name:SMIRNOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-338-0300
Mailing Address - Street 1:135 SEA BREEZE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-3701
Mailing Address - Country:US
Mailing Address - Phone:718-338-0300
Mailing Address - Fax:718-513-0424
Practice Address - Street 1:135 SEA BREEZE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-3701
Practice Address - Country:US
Practice Address - Phone:718-338-0300
Practice Address - Fax:718-513-0424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200156207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG17220Medicare UPIN
NY330931Medicare PIN