Provider Demographics
NPI:1720382674
Name:VADIM NAKHAMIYAYEV MD P.C.
Entity Type:Organization
Organization Name:VADIM NAKHAMIYAYEV MD P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VADIM
Authorized Official - Middle Name:ROMANOVICH
Authorized Official - Last Name:NAKHAMIYAYEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-536-3374
Mailing Address - Street 1:141 COMBS AVE
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1432
Mailing Address - Country:US
Mailing Address - Phone:516-569-0696
Mailing Address - Fax:
Practice Address - Street 1:2155 OCEAN AVE
Practice Address - Street 2:SUITE 1-B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1477
Practice Address - Country:US
Practice Address - Phone:347-305-3777
Practice Address - Fax:888-960-2621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-07
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250235208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty