Provider Demographics
NPI:1538187695
Name:AZBEL, VADIM (MD)
Entity type:Individual
Prefix:
First Name:VADIM
Middle Name:
Last Name:AZBEL
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 1:459 SAINT ANDREWS RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-1556
Mailing Address - Country:US
Mailing Address - Phone:917-501-0064
Mailing Address - Fax:
Practice Address - Street 1:459 SAINT ANDREWS RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-1556
Practice Address - Country:US
Practice Address - Phone:917-501-0064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2107552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01937484Medicaid
NY72M491Medicare PIN
NYG96251Medicare UPIN