Provider Demographics
NPI:1053791558
Name:VERBOFSKY, EVAN (DPM)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:VERBOFSKY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2236 RIDGE RD W
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624
Mailing Address - Country:US
Mailing Address - Phone:585-225-9452
Mailing Address - Fax:585-225-5323
Practice Address - Street 1:2236 RIDGE RD W
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624
Practice Address - Country:US
Practice Address - Phone:585-225-9452
Practice Address - Fax:585-225-5323
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006921213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery