Provider Demographics
NPI:1821653866
Name:VAKNIN, FLEAR (MD)
Entity Type:Individual
Prefix:DR
First Name:FLEAR
Middle Name:
Last Name:VAKNIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 GRAND STREET
Mailing Address - Street 2:JERSEY CITY MEDICAL CENTER
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302
Mailing Address - Country:US
Mailing Address - Phone:201-915-2000
Mailing Address - Fax:
Practice Address - Street 1:JERSEY CITY MEDICAL CENTER - OBGYN
Practice Address - Street 2:355 GRAND STREET
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302
Practice Address - Country:US
Practice Address - Phone:201-915-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program