Healthcare Provider Details

I. General information

NPI: 1992881569
Provider Name (Legal Business Name): VLADIMIR PRYJDUN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 01/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WOODS RD
VALHALLA NY
10595-1530
US

IV. Provider business mailing address

100 WOODS RD
VALHALLA NY
10595-1530
US

V. Phone/Fax

Practice location:
  • Phone: 914-493-7000
  • Fax: 914-493-8439
Mailing address:
  • Phone: 914-493-7000
  • Fax: 914-493-8439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number256443-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1992881569
Identifier TypeMEDICAID
Identifier StateDE
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: