Provider Demographics
NPI:1255628889
Name:LOBKOVA, NELYA (DPM)
Entity type:Individual
Prefix:
First Name:NELYA
Middle Name:
Last Name:LOBKOVA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2639 E 26TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2419
Mailing Address - Country:US
Mailing Address - Phone:718-753-9523
Mailing Address - Fax:
Practice Address - Street 1:291 BROADWAY # 810
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-1814
Practice Address - Country:US
Practice Address - Phone:212-606-4065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-04
Last Update Date:2020-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00322200213E00000X
NY006527213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03794305Medicaid
NYA300097541Medicare PIN