Provider Demographics
NPI:1801114442
Name:NAKHAMIYAYEV, VADIM ROMANOVICH (MD)
Entity type:Individual
Prefix:DR
First Name:VADIM
Middle Name:ROMANOVICH
Last Name:NAKHAMIYAYEV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:141 COMBS AVE
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1432
Mailing Address - Country:US
Mailing Address - Phone:516-569-0696
Mailing Address - Fax:516-569-3677
Practice Address - Street 1:2155 OCEAN AVE
Practice Address - Street 2:STE 1-B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1478
Practice Address - Country:US
Practice Address - Phone:347-305-3777
Practice Address - Fax:888-960-2621
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY250235208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03219472Medicaid
NY03219472Medicaid