Provider Demographics
NPI:1245294503
Name:NEKRITIN, VADIM (DPM)
Entity type:Individual
Prefix:DR
First Name:VADIM
Middle Name:
Last Name:NEKRITIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2306 AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4917
Mailing Address - Country:US
Mailing Address - Phone:718-769-8210
Mailing Address - Fax:718-769-8087
Practice Address - Street 1:2306 AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4917
Practice Address - Country:US
Practice Address - Phone:718-769-8210
Practice Address - Fax:718-769-8087
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006017213EP1101X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02569611Medicaid
NYPJ2561Medicare PIN
NY006612HMedicare ID - Type Unspecified
NYPYW051Medicare ID - Type Unspecified
NY02569611Medicaid