Healthcare Provider Details

I. General information

NPI: 1518008986
Provider Name (Legal Business Name): VAKKA PODIATRY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 AVENUE P
BROOKLYN NY
11204-4903
US

IV. Provider business mailing address

209 AVENUE P
BROOKLYN NY
11204-4903
US

V. Phone/Fax

Practice location:
  • Phone: 718-259-6666
  • Fax: 718-259-7000
Mailing address:
  • Phone: 718-259-6666
  • Fax: 718-259-7000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN004872
License Number StateNY

VIII. Authorized Official

Name: DR. INNA BLAKEMAN
Title or Position: PRESIDENT
Credential: DPM
Phone: 718-259-6666