Provider Demographics
NPI:1386962272
Name:VOLOSOV, ROCHELLE (DPM)
Entity type:Individual
Prefix:DR
First Name:ROCHELLE
Middle Name:
Last Name:VOLOSOV
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:ROCHELLE
Other - Middle Name:
Other - Last Name:RUBINOV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:1527 STATE ROUTE 27
Mailing Address - Street 2:STE 1100
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-3979
Mailing Address - Country:US
Mailing Address - Phone:908-421-4545
Mailing Address - Fax:732-960-5016
Practice Address - Street 1:1527 STATE ROUTE 27
Practice Address - Street 2:STE 1100
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-3979
Practice Address - Country:US
Practice Address - Phone:908-421-4545
Practice Address - Fax:732-960-5016
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD0031100213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ237917Medicare Oscar/Certification