Provider Demographics
NPI:1376901298
Name:VAMC
Entity Type:Organization
Organization Name:VAMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MARCEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KAGANOVSKAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-404-0710
Mailing Address - Street 1:300 E 34TH ST APT 8D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5209
Mailing Address - Country:US
Mailing Address - Phone:646-404-0710
Mailing Address - Fax:
Practice Address - Street 1:300 E 34TH ST APT 8D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5209
Practice Address - Country:US
Practice Address - Phone:646-404-0710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-06
Last Update Date:2016-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY340371261Q00000X, 282N00000X, 313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility