MEDICARE: BRIAN WOLLOCKO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1265182190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN WOLLOCKO MD

Provider Business Mailing Address
First Line	:	2601 OCEAN PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-7791
Country	:	US
Telephone Number	:	718-616-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	6150 RADIO WAY
Second Line	:
City	:	MASON
State	:	OH
Zip	:	45040-4520
Country	:	US
Telephone Number	:	513-984-5133
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2022
Last Update Date	:	03/17/2026

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Directions to “ BRIAN WOLLOCKO MD” Practice Location

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