Provider Demographics
NPI:1215949219
Name:VOLOVOY, VITALY (MD)
Entity type:Individual
Prefix:DR
First Name:VITALY
Middle Name:
Last Name:VOLOVOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 BRIGHTON BEACH AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5659
Mailing Address - Country:US
Mailing Address - Phone:718-975-0657
Mailing Address - Fax:718-975-0659
Practice Address - Street 1:1009 BRIGHTON BEACH AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5659
Practice Address - Country:US
Practice Address - Phone:718-975-0657
Practice Address - Fax:718-975-0659
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205549207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01786149Medicaid
NY01786149Medicaid
NYG59095Medicare UPIN