Provider Demographics
NPI:1124154273
Name:VASYUKEVICH, KONSTANTIN (MD)
Entity type:Individual
Prefix:DR
First Name:KONSTANTIN
Middle Name:
Last Name:VASYUKEVICH
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 1:59 E 79TH ST
Mailing Address - Street 2:FLOOR 1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0258
Mailing Address - Country:US
Mailing Address - Phone:212-380-3634
Mailing Address - Fax:
Practice Address - Street 1:59 E 79TH ST
Practice Address - Street 2:FL 1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0258
Practice Address - Country:US
Practice Address - Phone:212-380-3634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243176207YS0123X, 207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery