Provider Demographics
NPI:1174552889
Name:POGILDAKOV, VLAD (DC)
Entity type:Individual
Prefix:
First Name:VLAD
Middle Name:
Last Name:POGILDAKOV
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 1:2349 BENSON AVE
Mailing Address - Street 2:2G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-4351
Mailing Address - Country:US
Mailing Address - Phone:917-318-0784
Mailing Address - Fax:
Practice Address - Street 1:1201 DEERFIELD TER
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-5523
Practice Address - Country:US
Practice Address - Phone:646-546-8701
Practice Address - Fax:908-486-3325
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00612000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ099760XHWMedicare PIN
099760Medicare ID - Type Unspecified
V08887Medicare UPIN