Provider Demographics
NPI:1255686028
Name:VADIM SULER
Entity Type:Organization
Organization Name:VADIM SULER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SI
Authorized Official - Prefix:
Authorized Official - First Name:VADIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SULER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-382-1478
Mailing Address - Street 1:735 AVENUE W APT 5H
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-5527
Mailing Address - Country:US
Mailing Address - Phone:646-382-1478
Mailing Address - Fax:
Practice Address - Street 1:735 AVENUE W APT 5H
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-5527
Practice Address - Country:US
Practice Address - Phone:646-382-1478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY36000415252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency