Provider Demographics
NPI:1306013511
Name:MIKHAIL VOLOKITIN MEDICAL P.C.
Entity Type:Organization
Organization Name:MIKHAIL VOLOKITIN MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TATYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLOKITIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-665-3200
Mailing Address - Street 1:50 W 97TH ST
Mailing Address - Street 2:STE 1-B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6053
Mailing Address - Country:US
Mailing Address - Phone:212-665-3200
Mailing Address - Fax:212-665-4756
Practice Address - Street 1:50 W 97TH ST
Practice Address - Street 2:STE 1-B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6053
Practice Address - Country:US
Practice Address - Phone:212-665-3200
Practice Address - Fax:212-665-4756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205383204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01745495Medicaid
NYG47482Medicare UPIN