Provider Demographics
NPI:1801861265
Name:VASILYEVA, ALINA (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALINA
Middle Name:
Last Name:VASILYEVA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:ALINA
Other - Middle Name:
Other - Last Name:VASILYEVA-ROZINGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:1806 VOORHIES AVE
Mailing Address - Street 2:#1B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3648
Mailing Address - Country:US
Mailing Address - Phone:646-894-4168
Mailing Address - Fax:718-331-6720
Practice Address - Street 1:2116 AVENUE P
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1507
Practice Address - Country:US
Practice Address - Phone:718-338-1616
Practice Address - Fax:718-338-1898
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006046213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02638397Medicaid
NYPJ7121Medicare PIN
VO3476Medicare UPIN
NY02638397Medicaid