Provider Demographics
NPI:1942465091
Name:LARISA VEKSMAN D.O P.C
Entity Type:Organization
Organization Name:LARISA VEKSMAN D.O P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:VEKSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-891-8822
Mailing Address - Street 1:21 GOODALL ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-3325
Mailing Address - Country:US
Mailing Address - Phone:718-891-8822
Mailing Address - Fax:718-891-8823
Practice Address - Street 1:162 BRIGHTON 11TH ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5327
Practice Address - Country:US
Practice Address - Phone:718-891-8822
Practice Address - Fax:718-891-8823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223381174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY223381OtherLICENSE
NY223381OtherLICENSE