Provider Demographics
NPI:1518655778
Name:SMOLNIKOV, ANDRII (SA-C)
Entity Type:Individual
Prefix:MR
First Name:ANDRII
Middle Name:
Last Name:SMOLNIKOV
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 CENTER BLVD APT LONG
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11109-5901
Mailing Address - Country:US
Mailing Address - Phone:718-753-4227
Mailing Address - Fax:
Practice Address - Street 1:4545 CENTER BLVD APT LONG
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11109-5901
Practice Address - Country:US
Practice Address - Phone:171-875-3422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
21-689246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant