Provider Demographics
NPI:1447365382
Name:ALEXEYENKO, VLADIMIR (MD)
Entity type:Individual
Prefix:
First Name:VLADIMIR
Middle Name:
Last Name:ALEXEYENKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 WASHINGTON SQUARE WEST
Mailing Address - Street 2:SUITE 5F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014
Mailing Address - Country:US
Mailing Address - Phone:212-675-7780
Mailing Address - Fax:212-675-9801
Practice Address - Street 1:31 WASHINGTON SQ W
Practice Address - Street 2:5F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-9126
Practice Address - Country:US
Practice Address - Phone:212-675-7780
Practice Address - Fax:212-675-9801
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211233207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G86597Medicare UPIN
NYG86597Medicare UPIN