Provider Demographics
NPI:1528318573
Name:MARIO VOLOSHIN DPM PC
Entity type:Organization
Organization Name:MARIO VOLOSHIN DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLOSHIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:917-684-3435
Mailing Address - Street 1:6304 STRICKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6330
Mailing Address - Country:US
Mailing Address - Phone:718-389-4404
Mailing Address - Fax:718-389-5317
Practice Address - Street 1:102 NORMAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-2934
Practice Address - Country:US
Practice Address - Phone:718-389-4404
Practice Address - Fax:718-389-5317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0006441-1213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty