Provider Demographics
NPI:1013905173
Name:SZEREMETA, WASYL (MD MBA)
Entity Type:Individual
Prefix:DR
First Name:WASYL
Middle Name:
Last Name:SZEREMETA
Suffix:
Gender:M
Credentials:MD MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 OID COUNTRY ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803
Mailing Address - Country:US
Mailing Address - Phone:516-931-5552
Mailing Address - Fax:516-931-6563
Practice Address - Street 1:875 OID COUNTRY ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803
Practice Address - Country:US
Practice Address - Phone:516-931-5552
Practice Address - Fax:516-931-6563
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY258074207YP0228X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1603609Medicaid
893014GBTMedicare ID - Type Unspecified
G38956Medicare UPIN