Provider Demographics
NPI:1790037877
Name:SKOK, SERGHIY VLADIMIROVICH (NURSE, LPN)
Entity Type:Individual
Prefix:MR
First Name:SERGHIY
Middle Name:VLADIMIROVICH
Last Name:SKOK
Suffix:
Gender:M
Credentials:NURSE, LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 BRIGHTON 2ND ST
Mailing Address - Street 2:APT. 3 M
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-7533
Mailing Address - Country:US
Mailing Address - Phone:315-489-8330
Mailing Address - Fax:
Practice Address - Street 1:3100 BRIGHTON 2ND ST
Practice Address - Street 2:APT. 3 M
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7533
Practice Address - Country:US
Practice Address - Phone:315-489-8330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311584164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse