Healthcare Provider Details

I. General information

NPI: 1609039015
Provider Name (Legal Business Name): RACQUEL M VOLKOWITZ P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 03/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 6TH ST
BROOKLYN NY
11215-3609
US

IV. Provider business mailing address

1810 E 33RD ST
BROOKLYN NY
11234-4426
US

V. Phone/Fax

Practice location:
  • Phone: 718-780-3148
  • Fax: 718-780-3287
Mailing address:
  • Phone: 718-854-4256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number011025
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: