Provider Demographics
NPI:1891973525
Name:DR. NEAL M. VICHINSKY
Entity Type:Organization
Organization Name:DR. NEAL M. VICHINSKY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:VICHINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-389-1800
Mailing Address - Street 1:169 KENT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-2105
Mailing Address - Country:US
Mailing Address - Phone:718-389-1800
Mailing Address - Fax:718-349-7783
Practice Address - Street 1:169 KENT ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-2105
Practice Address - Country:US
Practice Address - Phone:718-389-1800
Practice Address - Fax:718-349-7783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002345213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0782760001Medicare NSC