Provider Demographics
NPI:1184291270
Name:PINKHASOV, VADIM (NP)
Entity type:Individual
Prefix:
First Name:VADIM
Middle Name:
Last Name:PINKHASOV
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 84
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-0084
Mailing Address - Country:US
Mailing Address - Phone:718-750-1665
Mailing Address - Fax:718-691-4916
Practice Address - Street 1:4232 FRANCIS LEWIS BLVD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2561
Practice Address - Country:US
Practice Address - Phone:718-750-1665
Practice Address - Fax:718-691-4916
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2024-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11015412363L00000X
NY347375363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner