Provider Demographics
NPI:1558537340
Name:TOMUTA, VLAD ANDREI (MD)
Entity Type:Individual
Prefix:
First Name:VLAD
Middle Name:ANDREI
Last Name:TOMUTA
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 1:1634 HERING AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2006
Mailing Address - Country:US
Mailing Address - Phone:347-398-9287
Mailing Address - Fax:
Practice Address - Street 1:111 E 210TH ST RM G161
Practice Address - Street 2:MOSES GOLD ZONE, MAIN FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2401
Practice Address - Country:US
Practice Address - Phone:646-492-1790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY260432282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program