Provider Demographics
NPI:1053942797
Name:NEW YORK VASCULAR MEDICINE PLLC
Entity type:Organization
Organization Name:NEW YORK VASCULAR MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:LEV
Authorized Official - Middle Name:
Authorized Official - Last Name:PUKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-737-7200
Mailing Address - Street 1:3049 OCEAN PKWY STE 303
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-8367
Mailing Address - Country:US
Mailing Address - Phone:718-737-7200
Mailing Address - Fax:888-960-2493
Practice Address - Street 1:3049 OCEAN PKWY STE 303
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8367
Practice Address - Country:US
Practice Address - Phone:718-737-7200
Practice Address - Fax:888-960-2493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty