Provider Demographics
NPI:1396933347
Name:AZBEL, VADIM V (PT)
Entity type:Individual
Prefix:MR
First Name:VADIM
Middle Name:V
Last Name:AZBEL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 BRIGHTON 5TH ST
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-7044
Mailing Address - Country:US
Mailing Address - Phone:718-934-1920
Mailing Address - Fax:718-934-2078
Practice Address - Street 1:3120 BRIGHTON 5TH ST
Practice Address - Street 2:SUITE 1C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7044
Practice Address - Country:US
Practice Address - Phone:718-934-1920
Practice Address - Fax:718-934-2078
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029450225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist