Provider Demographics
NPI:1801054135
Name:ALINA VASILYEVA-ROZINGER, D.P.M., P.C.
Entity type:Organization
Organization Name:ALINA VASILYEVA-ROZINGER, D.P.M., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VASILYEVA-ROZINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-646-0131
Mailing Address - Street 1:1806 VOORHIES AVE APT 1B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3648
Mailing Address - Country:US
Mailing Address - Phone:718-646-0131
Mailing Address - Fax:718-646-0131
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006046-01332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2638397Medicaid
NYPQWW21Medicare PIN
NYV03467Medicare UPIN
NY2638397Medicaid