Provider Demographics
NPI:1356084503
Name:KOROBEYNIKOV, VLADISLAV (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:VLADISLAV
Middle Name:
Last Name:KOROBEYNIKOV
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:VLAD
Other - Middle Name:
Other - Last Name:KOROBEYNIKOV
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:630 W 168TH ST PH 15-124
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3725
Mailing Address - Country:US
Mailing Address - Phone:332-257-7741
Mailing Address - Fax:
Practice Address - Street 1:630 W 168TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3725
Practice Address - Country:US
Practice Address - Phone:332-257-7741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-15
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program