Provider Demographics
NPI:1841218039
Name:KUZNETSOV, VALERY (MD)
Entity Type:Individual
Prefix:DR
First Name:VALERY
Middle Name:
Last Name:KUZNETSOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 FOSTER AVE STE D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-2130
Mailing Address - Country:US
Mailing Address - Phone:718-431-8936
Mailing Address - Fax:718-431-9607
Practice Address - Street 1:202 FOSTER AVE STE D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-2130
Practice Address - Country:US
Practice Address - Phone:718-431-8936
Practice Address - Fax:718-431-9607
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207084174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY63B031Medicare ID - Type Unspecified