Provider Demographics
NPI:1013296136
Name:PLAXINE, VADIM (DPT)
Entity Type:Individual
Prefix:
First Name:VADIM
Middle Name:
Last Name:PLAXINE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 W 24TH ST APT 15D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-2353
Mailing Address - Country:US
Mailing Address - Phone:718-259-0639
Mailing Address - Fax:718-259-0639
Practice Address - Street 1:1580 DAHILL RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-3537
Practice Address - Country:US
Practice Address - Phone:718-375-2505
Practice Address - Fax:718-375-2472
Is Sole Proprietor?:No
Enumeration Date:2011-08-07
Last Update Date:2011-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034047225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist