Provider Demographics
NPI:1346269511
Name:HOLLOWBROOK FOOT SPECIALIST, PC
Entity Type:Organization
Organization Name:HOLLOWBROOK FOOT SPECIALIST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YAVOR
Authorized Official - Middle Name:I
Authorized Official - Last Name:GESHEV
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:845-298-9074
Mailing Address - Street 1:89 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-2505
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:89 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-2505
Practice Address - Country:US
Practice Address - Phone:845-298-9074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003798213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PBWG11Medicare UPIN
NY6107200001Medicare NSC