Provider Demographics
NPI:1609021476
Name:MYKHALSKYY, VLADYSLAV (MD)
Entity Type:Individual
Prefix:DR
First Name:VLADYSLAV
Middle Name:
Last Name:MYKHALSKYY
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 1:4140 CARPENTER AVE
Mailing Address - Street 2:1E
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2650
Mailing Address - Country:US
Mailing Address - Phone:718-920-9123
Mailing Address - Fax:
Practice Address - Street 1:4140 CARPENTER AVE
Practice Address - Street 2:1E
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2650
Practice Address - Country:US
Practice Address - Phone:718-920-9123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131740114174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist