Dr. Vadim Kolesnikov

NPI1871652974

Summary

Provider Details

NPI Number 1871652974
Provider Name Vadim Kolesnikov
Credential
Specialization
Medical School Name Icahn School Of Medicine At Mount Sinai
Graduation Year 1995
Gender M
Entity Type Individual
PAC ID by PECOS 0244360535
Professional Enrollment ID I20100614000114
Enumeration Date 12/06/2006
Last Update Date 07/08/2007

Contact Details

Business Practice address 2560 OCEAN AVE, Brooklyn,
11229-4507 New York View on Google Map
Business Practice phone 718-615-4100
Business Practice fax 718-615-4111
Mailing address 2560 OCEAN AVE, Brooklyn,
11229-4507 New York View on Google Map
Other phone 718-615-4100
Other fax 718-615-4111
Email Address shannonfig@domain.com Reval Email Address
Incorrect information? Update the NPI Details for Vadim Kolesnikov Update NPI

Payments

Total Payment Worth

$14,233.04
from 43 payments in the last 6 years

Total Cash or Cash Equivalent

$440.79
from 11 payments in the last 6 years

Total In-kind Items & Services

$13,792.25
from 32 payments in the last 6 years

Hospital Affilitation

Practices in Brooklyn

Brooklyn, New York

Education & Training

Icahn School Of Medicine At Mount Sinai

1995

Group Affiliation

Organization Name PECOS PAC ID Members
Sinai Diagnostics And Interventional Radiology Pc 7416846274 5

Public Reporting for Performance Scores

More Details

Final MIPS Score

60 out of 100

Score Breakdown

Quality Category Score 0
PI Category Score 0

 

IA Category Score 0
Cost Category Score 0
Total Patients: 82
Source of Scores: individual
Newsletter for Healthcare Professionals

Provider Taxonomy Details

Primary Taxonomy
Speciality
Grouping name
Taxonomy
License No.
206290-1 (New York)

Reference NPI Information (as per NPPES NPI Record)

Field Name Field Value
NPI 1871652974
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Entity Type Individual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Is Sole Proprietor Y
Indicate whether provider is a sole proprietor.
  • A sole proprietor is the sole (the only) owner of a business that is not incorporated; that unincorporated business is a sole proprietorship.
  • In a sole proprietorship, the sole proprietor owns all of the assets of the business and is solely liable for all of the debts of the business.
  • There is no difference between a sole proprietorship and a sole proprietor; they are legally a single entity: an individual.
  • In terms of NPI assignment, a sole proprietor is an Entity type 1 (Individual) and is eligible for only one NPI (the sole proprietorship business is not eligible for its own NPI).
  • As an individual, a sole proprietorship cannot be a subpart and cannot have subparts. (See NPI Final Rule for information about subparts.)
  • A sole proprietorship may or may not have employees.
  • Often, the IRS assigns an EIN to a sole proprietorship in order to protect the sole proprietor's SSN from disclosure in claims or on W-2s. NPPES does not capture a sole proprietorship's EIN.
  • Many types of health care providers could be sole proprietorships (for example, group practices, pharmacies, home health agencies).
Provider Last Name (Legal Name) Kolesnikov
The last name of the provider (if an individual). If the provider is an individual, this is the legal name. This name must match the name on file with the Social Security Administration (SSA). In addition, the date of birth must match that on file with SSA. (First and last names are required for initial applications.) The First, Middle, Last and Credential(s) fields allow the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Name Vadim
The first name of the provider, if the provider is an individual.
Provider Credential Text M.D.
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider First Line Business Mailing Address 2560 OCEAN AVE
The first line mailing address of the provider being identified. This data element may contain the same information as ''Provider first line location address''.
Provider Business Mailing Address City Name Brooklyn
The City name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address City name''.
Provider Business Mailing Address State Name New York
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address State name''.
Provider Business Mailing Address Postal Code 11229-4507
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ''Provider location address postal code''.
Provider Business Mailing Address Country Code US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address country code''.
Provider Business Mailing Address Telephone Number 718-615-4100
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ''Provider location address telephone number''.
Provider Business Mailing Address Fax Number 718-615-4111
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address fax number''.
Provider First Line Business Practice Location Address 2560 OCEAN AVE
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name Brooklyn
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name New York
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code 11229-4507
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number 718-615-4100
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number 718-615-4111
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date 12/06/2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date 07/08/2007
The date that a record was last updated or changed.
Provider Gender Code M
The code designating the provider's gender if the provider is a person.
Provider Gender Male
The provider's gender if the provider is a person.
Healthcare Provider Taxonomy Code #1 174400000X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1 An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
Healthcare Provider Taxonomy #1
Provider License Number 1 206290-1
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1 NY
Provider License Number State Code #1
Healthcare Provider Primary Taxonomy Switch 1 Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.