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General NPI Number Information
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NPI Number | 1861572364
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Entity Type | Individual
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Provider Name | NYKOLAI VASIL PIDHORODECKYJ MD
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Gender | Male
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 15251 PLEASANT VALLEY RD # RE-16
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City | CENTER CITY
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State | MN
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Zip | 55012-9640
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Country | US
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Telephone | 651-213-4086
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Fax | 330-606-5514
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Provider Business Mailing Address
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Address Line | 4280 COBBLESTONE DR
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City | COPLEY
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State | OH
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Zip | 44321-2926
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Country | US
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Telephone | 330-606-5514
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | 35-079642
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License Number State | OH
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