MEDICARE: VADIM PINKHASOV NP

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	363L00000X	Nurse Practitioner	APRN11015412	FL
2	363L00000X	Nurse Practitioner	347375	NY

General Provider Information

NPI Number	:	1184291270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VADIM PINKHASOV NP

Provider Business Mailing Address
First Line	:	PO BOX 84
Second Line	:
City	:	ROSLYN HEIGHTS
State	:	NY
Zip	:	11577-0084
Country	:	US
Telephone Number	:	718-750-1665
Fax Number	:	718-691-4916

Provider Business Practice Location Address
First Line	:	4232 FRANCIS LEWIS BLVD
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11361-2561
Country	:	US
Telephone Number	:	718-750-1665
Fax Number	:	718-691-4916

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2021
Last Update Date	:	08/03/2024

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