Healthcare Provider Details

I. General information

NPI: 1700697810
Provider Name (Legal Business Name): DOWNTOWN VEIN AND VASCULAR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 E OAKDENE AVE UNIT A
PALISADES PARK NJ
07650-1630
US

IV. Provider business mailing address

117 W CENTRAL BLVD UNIT 16
PALISADES PARK NJ
07650-5002
US

V. Phone/Fax

Practice location:
  • Phone: 646-267-3432
  • Fax:
Mailing address:
  • Phone: 646-267-3432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SERGEI SOBOLEVSKY
Title or Position: OWNER
Credential: MD
Phone: 646-267-3432