Provider Demographics
NPI:1194961565
Name:VILENSKIY, VLADIMIR (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:VLADIMIR
Middle Name:
Last Name:VILENSKIY
Suffix:
Gender:M
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 NORFOLK ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2305
Mailing Address - Country:US
Mailing Address - Phone:718-344-1829
Mailing Address - Fax:718-891-1365
Practice Address - Street 1:125 NORFOLK ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2305
Practice Address - Country:US
Practice Address - Phone:718-344-1829
Practice Address - Fax:718-891-1365
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015450235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist