Provider Demographics
NPI:1295824233
Name:DOLSKY, VADIM (LAC)
Entity Type:Individual
Prefix:
First Name:VADIM
Middle Name:
Last Name:DOLSKY
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11045 QUEENS BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5501
Mailing Address - Country:US
Mailing Address - Phone:718-294-5000
Mailing Address - Fax:718-294-6060
Practice Address - Street 1:11045 QUEENS BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5501
Practice Address - Country:US
Practice Address - Phone:718-294-5000
Practice Address - Fax:718-294-6060
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001242-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001242-1OtherLICENSE #