Provider Demographics
NPI:1366984890
Name:VIGDORCHIK, YURI
Entity type:Individual
Prefix:MR
First Name:YURI
Middle Name:
Last Name:VIGDORCHIK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 PARTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-4017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:493 HERITAGE RD
Practice Address - Street 2:SUITE 1C
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-3879
Practice Address - Country:US
Practice Address - Phone:203-586-1385
Practice Address - Fax:631-619-6680
Is Sole Proprietor?:No
Enumeration Date:2016-11-15
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0001680225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist