Provider Demographics
NPI:1467740118
Name:ZHIGIN, VADIM (PA)
Entity Type:Individual
Prefix:
First Name:VADIM
Middle Name:
Last Name:ZHIGIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 OCEAN PKWY
Mailing Address - Street 2:APT 1E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-7748
Mailing Address - Country:US
Mailing Address - Phone:347-645-9028
Mailing Address - Fax:
Practice Address - Street 1:2620 OCEAN PKWY
Practice Address - Street 2:APT 1E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7748
Practice Address - Country:US
Practice Address - Phone:347-645-9028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-15
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014835-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant