Provider Demographics
NPI:1245367416
Name:ADAPTATION MEDICAL, PC
Entity type:Organization
Organization Name:ADAPTATION MEDICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VLADIMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:ONEFATER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-714-6995
Mailing Address - Street 1:20701 ESTATES DR
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1180
Mailing Address - Country:US
Mailing Address - Phone:718-714-6995
Mailing Address - Fax:718-714-9346
Practice Address - Street 1:3007 OCEAN PKWY
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8302
Practice Address - Country:US
Practice Address - Phone:718-714-6995
Practice Address - Fax:718-714-9346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215829207R00000X
NY220248174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02133017Medicaid
NY02133017Medicaid
NY417R4EP021Medicare PIN
NYH32125Medicare UPIN