Provider Demographics
NPI:1053536433
Name:WNUK, VLADIMIR IGNATIUS
Entity type:Individual
Prefix:
First Name:VLADIMIR
Middle Name:IGNATIUS
Last Name:WNUK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-6838
Mailing Address - Country:US
Mailing Address - Phone:212-691-7004
Mailing Address - Fax:212-691-7004
Practice Address - Street 1:183 NASSAU AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-6838
Practice Address - Country:US
Practice Address - Phone:718-389-3622
Practice Address - Fax:718-389-3622
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCO8232Medicare UPIN
NY311431Medicare ID - Type Unspecified