Healthcare Provider Details

I. General information

NPI: 1376928192
Provider Name (Legal Business Name): MR. VLADIMIR IOFFE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2015
Last Update Date: 07/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2960 OCEAN AVENUE 6TH FLOOR PETRYCHENKO PHYSICIAN PC.
BROOKLYN NY
11235
US

IV. Provider business mailing address

2960 OCEAN AVENUE 6TH FLOOR PETRYCHENKO PHYSICIAN PC.
BROOKLYN NY
11235
US

V. Phone/Fax

Practice location:
  • Phone: 718-336-5123
  • Fax: 718-336-5137
Mailing address:
  • Phone: 718-336-5123
  • Fax: 718-336-5137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZX2200X
TaxonomyOrthopedic Assistant
License NumberO000100-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: