Provider Demographics
NPI:1346954237
Name:SV ADULT HEALTH NP P.C.
Entity Type:Organization
Organization Name:SV ADULT HEALTH NP P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SERGEY
Authorized Official - Middle Name:
Authorized Official - Last Name:VASSILEVICH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:347-841-2663
Mailing Address - Street 1:3727 AMBOY RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-2519
Mailing Address - Country:US
Mailing Address - Phone:929-877-0122
Mailing Address - Fax:718-691-4947
Practice Address - Street 1:158 BRIGHTON 11TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5327
Practice Address - Country:US
Practice Address - Phone:718-407-6333
Practice Address - Fax:718-691-4947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care