Provider Demographics
NPI:1952403933
Name:VOLFINZON, LEONID (MD)
Entity Type:Individual
Prefix:
First Name:LEONID
Middle Name:
Last Name:VOLFINZON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 ARBUTUS AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-4500
Mailing Address - Country:US
Mailing Address - Phone:718-787-0700
Mailing Address - Fax:718-787-9061
Practice Address - Street 1:728 OCEAN VIEW AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6308
Practice Address - Country:US
Practice Address - Phone:718-787-0700
Practice Address - Fax:718-787-9061
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198165207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01551413Medicaid
NY66J092Medicare PIN
NYF96160Medicare UPIN
NY01551413Medicaid