Healthcare Provider Details

I. General information

NPI: 1528293958
Provider Name (Legal Business Name): HIPOCTATUS MEDICAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2009
Last Update Date: 05/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 LORRAINE STREET
BROOKLYN NY
11231-1223
US

IV. Provider business mailing address

702 OCEAN PARKWAY
BROOKLYN NY
11230-1133
US

V. Phone/Fax

Practice location:
  • Phone: 917-499-8509
  • Fax:
Mailing address:
  • Phone: 718-854-3005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number212904
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number183024
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number156503
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN005136
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number205549
License Number StateNY

VIII. Authorized Official

Name: VITALY VOLOVOY
Title or Position: INTERNAL
Credential: M.D.
Phone: 917-499-8509