Provider Demographics
NPI:1447561261
Name:GRECHUSHKIN, VADIM (MD)
Entity Type:Individual
Prefix:DR
First Name:VADIM
Middle Name:
Last Name:GRECHUSHKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 N BAYSHORE DR APT 4901
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-3219
Mailing Address - Country:US
Mailing Address - Phone:718-710-5033
Mailing Address - Fax:
Practice Address - Street 1:650 1ST AVE FL 7
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3280
Practice Address - Country:US
Practice Address - Phone:212-263-9531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-25
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2614852085R0202X
NY2637042085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology