Provider Demographics
NPI:1326219924
Name:FOMIN, SVETLANA (MD)
Entity type:Individual
Prefix:
First Name:SVETLANA
Middle Name:
Last Name:FOMIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:113 AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-7760
Mailing Address - Country:US
Mailing Address - Phone:732-685-1566
Mailing Address - Fax:
Practice Address - Street 1:5000 BRITTONFIELD PKWY STE B150
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9215
Practice Address - Country:US
Practice Address - Phone:315-766-1627
Practice Address - Fax:315-201-8711
Is Sole Proprietor?:No
Enumeration Date:2008-03-21
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA08122400207RE0101X
NY309596207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism