Provider Demographics
NPI:1376928192
Name:IOFFE, VLADIMIR
Entity Type:Individual
Prefix:MR
First Name:VLADIMIR
Middle Name:
Last Name:IOFFE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2960 OCEAN AVENUE 6TH FLOOR
Mailing Address - Street 2:PETRYCHENKO PHYSICIAN PC.
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235
Mailing Address - Country:US
Mailing Address - Phone:718-336-5123
Mailing Address - Fax:718-336-5137
Practice Address - Street 1:2960 OCEAN AVENUE 6TH FLOOR
Practice Address - Street 2:PETRYCHENKO PHYSICIAN PC.
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235
Practice Address - Country:US
Practice Address - Phone:718-336-5123
Practice Address - Fax:718-336-5137
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYO000100-1246ZX2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZX2200XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherOrthopedic Assistant