Provider Demographics
NPI:1578944492
Name:VALLEY STREAM DIAGNOSTIC MEDICINE P.C.
Entity Type:Organization
Organization Name:VALLEY STREAM DIAGNOSTIC MEDICINE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEKSANDR
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-942-5686
Mailing Address - Street 1:501 BRIGHTON BEACH AVE
Mailing Address - Street 2:2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6403
Mailing Address - Country:US
Mailing Address - Phone:718-942-5686
Mailing Address - Fax:
Practice Address - Street 1:501 BRIGHTON BEACH AVE
Practice Address - Street 2:2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6403
Practice Address - Country:US
Practice Address - Phone:718-942-5686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2096012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty