Individual
LARISSA FOMITCHEVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
57 W SUNRISE HWY, LINDENHURST, NY 11757-2426
(631) 466-5242
(866) 468-0236
Mailing address
57 W SUNRISE HWY, LINDENHURST, NY 11757-2426
(347) 523-0054
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
241373
NY
Other
Enumeration date
08/11/2006
Last updated
08/30/2024
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