Provider Demographics
NPI:1922494418
Name:POMINOV, SVITLANA (MD)
Entity Type:Individual
Prefix:
First Name:SVITLANA
Middle Name:
Last Name:POMINOV
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SVITLANA
Other - Middle Name:
Other - Last Name:TALABAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:M10C PINE TREE BLVD
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3146
Mailing Address - Country:US
Mailing Address - Phone:848-525-0028
Mailing Address - Fax:
Practice Address - Street 1:234 E 149TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5504
Practice Address - Country:US
Practice Address - Phone:718-579-5874
Practice Address - Fax:718-579-4836
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10366400207R00000X
282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine