Provider Demographics
NPI:1043486285
Name:SHMERKOVICH, DMITRY V (DO)
Entity Type:Individual
Prefix:
First Name:DMITRY
Middle Name:V
Last Name:SHMERKOVICH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2711 AVENUE X APT 3E
Mailing Address - Street 2:MEDICAL STAFF OFFICE T14
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2028
Mailing Address - Country:US
Mailing Address - Phone:646-641-8292
Mailing Address - Fax:847-656-2324
Practice Address - Street 1:2711 AVENUE X APT 3E
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2028
Practice Address - Country:US
Practice Address - Phone:646-641-8292
Practice Address - Fax:847-656-2324
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2587292084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYFS2454825OtherDEA