Doctor Name: | LARISSA FOMITCHEVA |
NPI Number: | 1780695718 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | 241373 |
Business Practice Address: | 980 N Broadway N Massapequa, NY - 117582355 |
Business Phone Number: | 5167952890 |
Business Fax Number: | 5167957450 |
Mailing Address: | 2329 E 21st St, BROOKLYN |
State: | NY |
Postal Code: | 112294801 |
Phone Number: | 3475230054 |
Fax Number: | |
NPI Enumeration Date: | 08/11/2006 |
NPI Last Update Date: | 09/22/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 207V00000X |
License Number: | 241373 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Obstetrics & Gynecology |
Taxonomy Specialization: | |
Taxonomy Definition: | An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |