Basic Information
| Provider Information | |||||||||
| NPI: | 1477514644 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VISHNYAK | ||||||||
| FirstName: | OLEG | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1915 SEAGIRT BLVD | ||||||||
| Address2: | APT 12F | ||||||||
| City: | FAR ROCKWAY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11691 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184717833 | ||||||||
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| Practice Location | |||||||||
| Address1: | 270-05 76TH AVE | ||||||||
| Address2: | SUITE 0-4000 | ||||||||
| City: | NEW HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184707460 | ||||||||
| FaxNumber: | 7183431438 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2006 | ||||||||
| LastUpdateDate: | 05/10/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 010656 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.