Provider Demographics
NPI:1346067642
Name:DOWNTOWN VEIN AND VASCULAR OF PENN PLLC
Entity type:Organization
Organization Name:DOWNTOWN VEIN AND VASCULAR OF PENN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SERGEI
Authorized Official - Middle Name:
Authorized Official - Last Name:SOBOLEVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:929-924-6024
Mailing Address - Street 1:40 E OAKDENE AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-1630
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40 E OAKDENE AVE UNIT A
Practice Address - Street 2:
Practice Address - City:PALISADES PARK
Practice Address - State:NJ
Practice Address - Zip Code:07650-1630
Practice Address - Country:US
Practice Address - Phone:718-393-5559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty