Provider Demographics
NPI:1598998411
Name:FADEEV, PAVEL (PSYD)
Entity type:Individual
Prefix:DR
First Name:PAVEL
Middle Name:
Last Name:FADEEV
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 WEST END AVE
Mailing Address - Street 2:SUITE 2-C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024
Mailing Address - Country:US
Mailing Address - Phone:347-461-4446
Mailing Address - Fax:
Practice Address - Street 1:585 SCHENECTADY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1891
Practice Address - Country:US
Practice Address - Phone:718-604-5928
Practice Address - Fax:718-604-5699
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018621103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist