Provider Demographics
NPI:1073529731
Name:LATVINSKY, OLEG (DPM)
Entity Type:Individual
Prefix:
First Name:OLEG
Middle Name:
Last Name:LATVINSKY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 MILL AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6424
Mailing Address - Country:US
Mailing Address - Phone:718-616-0137
Mailing Address - Fax:347-374-4053
Practice Address - Street 1:2705 MERMAID AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-2005
Practice Address - Country:US
Practice Address - Phone:718-265-2222
Practice Address - Fax:718-333-1023
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005977213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02553735Medicaid
NY02553735Medicaid
NYU98894Medicare UPIN
NYPJ2121Medicare ID - Type Unspecified