Provider Demographics
NPI:1194971069
Name:VOROBYEVA, LARISA (MD)
Entity type:Individual
Prefix:DR
First Name:LARISA
Middle Name:
Last Name:VOROBYEVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LARISA
Other - Middle Name:
Other - Last Name:VOROBYEVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1460 W 5TH ST STE M2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-4071
Mailing Address - Country:US
Mailing Address - Phone:917-696-4857
Mailing Address - Fax:
Practice Address - Street 1:1460 W 5TH ST STE M2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-4071
Practice Address - Country:US
Practice Address - Phone:718-774-7437
Practice Address - Fax:718-483-8843
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255172207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03276620Medicaid
NY03276620Medicaid