Provider Demographics
NPI:1063673416
Name:VOLOSHIN, MARIO (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:
Last Name:VOLOSHIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:MARYAN
Other - Middle Name:
Other - Last Name:VOLOSHIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:165 NASSAU AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-4023
Mailing Address - Country:US
Mailing Address - Phone:718-389-4404
Mailing Address - Fax:718-389-5317
Practice Address - Street 1:165 NASSAU AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-4023
Practice Address - Country:US
Practice Address - Phone:718-389-4044
Practice Address - Fax:718-389-5317
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3520213ES0103X
NJ25MD00312400213ES0103X
NYN006441-1213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03493730Medicaid