MEDICARE: VRD GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1891453569
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VRD GROUP

Provider Business Mailing Address
First Line	:	2550 W 13TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-5813
Country	:	US
Telephone Number	:	718-300-5775
Fax Number	:

Provider Business Practice Location Address
First Line	:	2550 W 13TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-5813
Country	:	US
Telephone Number	:	718-300-5775
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DMITRIY AZAYEV
Credential	:
Telephone Number	:	718-207-1802

Provider Enumeration Date	:	11/30/2021
Last Update Date	:	11/30/2021

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Directions to “VRD GROUP ” Practice Location

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