MEDICARE: VADIM ZHIGIN P.A.

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	363A00000X	Physician Assistant	014835-1	NY

General Provider Information

NPI Number	:	1467740118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VADIM ZHIGIN P.A.

Provider Business Mailing Address
First Line	:	2620 OCEAN PKWY
Second Line	:	APT 1E
City	:	BROOKLYN
State	:	NY
Zip	:	11235-7748
Country	:	US
Telephone Number	:	347-645-9028
Fax Number	:

Provider Business Practice Location Address
First Line	:	2620 OCEAN PKWY
Second Line	:	APT 1E
City	:	BROOKLYN
State	:	NY
Zip	:	11235-7748
Country	:	US
Telephone Number	:	347-645-9028
Fax Number	:

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

Provider Enumeration Date	:	07/15/2011
Last Update Date	:	07/15/2011

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