Provider Demographics
NPI:1598731564
Name:VOLOKH, VLADIMIR (DO)
Entity Type:Individual
Prefix:
First Name:VLADIMIR
Middle Name:
Last Name:VOLOKH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 SAND LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4512
Mailing Address - Country:US
Mailing Address - Phone:718-644-3848
Mailing Address - Fax:718-556-6389
Practice Address - Street 1:288 SAND LN
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-4512
Practice Address - Country:US
Practice Address - Phone:718-644-3848
Practice Address - Fax:718-556-6389
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224973207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2111Q1OtherBLUECROSS BLUESHIELD
NY02354992Medicaid
NY2111Q1OtherBLUECROSS BLUESHIELD
H80960Medicare UPIN
NYA400017385Medicare PIN