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General NPI Number Information
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NPI Number | 1801992540
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Entity Type | Organization
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Legal Business Name | NASSAU MEDICAL SERVICES P.C.
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2511 AVENUE I STE 3
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City | BROOKLYN
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State | NY
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Zip | 11210-2800
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Country | US
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Telephone | 718-701-3252
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Fax | 718-758-1555
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Provider Business Mailing Address
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Address Line | 2511 AVENUE I STE 3
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City | BROOKLYN
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State | NY
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Zip | 11210-2800
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Country | US
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Telephone | 718-701-3252
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Fax | 718-758-1555
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Authorized Official
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Title or Position | PRESIDENT / MEDICAL DIRECTOR
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Name | DR. VADIM DAVYDOV
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Credential | D.O.
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Telephone | 718-701-3252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 223297
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License Number State | NY
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