Provider Demographics
NPI:1023291820
Name:VALDBERG, DORA EVEGENII (DPM)
Entity type:Individual
Prefix:MRS
First Name:DORA
Middle Name:EVEGENII
Last Name:VALDBERG
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 1:1410 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-4101
Mailing Address - Country:US
Mailing Address - Phone:718-837-1031
Mailing Address - Fax:718-837-1671
Practice Address - Street 1:1410 W 3RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-4101
Practice Address - Country:US
Practice Address - Phone:718-837-1031
Practice Address - Fax:718-837-1671
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006233-1213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN006233-1OtherLICENSE
NYN006233-1OtherLICENSE