Vyacheslav Pastukh, APN

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

26NJ01055900 Issued in NJ

Practice address

1100 E Chestnut Ave
Vineland, NJ 08360-5002

Phone

(856) 696-0108

NPI assigned

Sep 27, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: vyacheslav.pastukh.1@12810.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/12810/brand/1/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Excelcare Alliance, LLC

  • Family Medicine Physician
  • Vineland, NJ
  • NPI 1891090510
  Medicare reassignment NPD
• Dendrinos Medical Associates, P.a.

  • General Practice Physician
  • Vineland, NJ
  • NPI 1386839603
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1601164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601164800000",
    "number": "1457968182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1882 WYNNEWOOD DR",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "083616771",
            "telephone_number": "856-777-3968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 E CHESTNUT AVE",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "083605002",
            "telephone_number": "856-696-0108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PASTUKH",
        "first_name": "VYACHESLAV",
        "credential": "APN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-09-27",
        "last_updated": "2020-09-27",
        "certification_date": "2020-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NJ",
            "license": "26NJ01055900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kiritkumar A Parmar, MD
• Gwyn Mary Parris-Atwell, APN-C
• Gregory Andrew Parson, D.O.
• Partners Pharmacy LLC
• Partners Pharmacy LLC
• Akshika Patel
• Bhavna K Patel, MD, FAAP
• Chintan Patel, PT/DPT
• Dillon Mitesh Patel, DMD
• Ekta Patel, MD

• Gerontology Nurse Practitioner in Vineland, NJ
• Providers in Vineland, NJ by specialty
• Gerontology Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.