Provider Demographics
NPI:1740244771
Name:KUSHNERIK, VADIM (MD)
Entity type:Individual
Prefix:
First Name:VADIM
Middle Name:
Last Name:KUSHNERIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 INDIANA PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6906
Mailing Address - Country:US
Mailing Address - Phone:212-943-4999
Mailing Address - Fax:212-943-4999
Practice Address - Street 1:80 BROAD ST STE 1401
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-2249
Practice Address - Country:US
Practice Address - Phone:212-312-5247
Practice Address - Fax:212-312-5217
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217486-1208VP0000X, 208VP0014X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02132841Medicaid
P00154899OtherRAILROAD MEDICARE
H32423Medicare UPIN
NY5L51310Medicare PIN