Provider Demographics
NPI:1063660017
Name:ANISKIN, DMITRY BORISOVICH (MD)
Entity Type:Individual
Prefix:DR
First Name:DMITRY
Middle Name:BORISOVICH
Last Name:ANISKIN
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 1:104 EMERSON PL
Mailing Address - Street 2:1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-2604
Mailing Address - Country:US
Mailing Address - Phone:646-379-8047
Mailing Address - Fax:212-420-2181
Practice Address - Street 1:104 EMERSON PL
Practice Address - Street 2:1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-2604
Practice Address - Country:US
Practice Address - Phone:646-379-8047
Practice Address - Fax:212-420-2181
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2599662084P0802X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03063247Medicaid
NY03063247Medicaid