Provider Demographics
NPI:1992078018
Name:VAYNSHTEYN, ROMAN VLADIMIROVICH (DC)
Entity type:Individual
Prefix:
First Name:ROMAN
Middle Name:VLADIMIROVICH
Last Name:VAYNSHTEYN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1656 E 21ST ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-5070
Mailing Address - Country:US
Mailing Address - Phone:917-482-8184
Mailing Address - Fax:718-769-3255
Practice Address - Street 1:1656 E 21ST ST
Practice Address - Street 2:SUITE E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-5070
Practice Address - Country:US
Practice Address - Phone:917-482-8184
Practice Address - Fax:718-769-3255
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009716-2111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX3I391Medicare PIN