Provider Demographics
NPI:1235765587
Name:KURNOV, VLADLEN A (APN, CHPN)
Entity Type:Individual
Prefix:
First Name:VLADLEN
Middle Name:A
Last Name:KURNOV
Suffix:
Gender:M
Credentials:APN, CHPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-2442
Mailing Address - Country:US
Mailing Address - Phone:551-795-5761
Mailing Address - Fax:
Practice Address - Street 1:71 ALDER AVE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-6131
Practice Address - Country:US
Practice Address - Phone:551-795-5761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY612057163W00000X
NYF310210363LA2200X
NJ26NJ01132300363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health