Provider Demographics
NPI:1760456891
Name:VLADIMIR GINZBURT
Entity Type:Organization
Organization Name:VLADIMIR GINZBURT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:VLADIMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:GINZBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-714-4165
Mailing Address - Street 1:573 GRAND ST
Mailing Address - Street 2:D702
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-4381
Mailing Address - Country:US
Mailing Address - Phone:917-714-4165
Mailing Address - Fax:
Practice Address - Street 1:373 BROADWAY
Practice Address - Street 2:RM E17
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-3926
Practice Address - Country:US
Practice Address - Phone:917-714-4165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200607174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY47M331Medicare ID - Type Unspecified