Provider Demographics
NPI:1205045853
Name:DRD MEDICAL PC
Entity Type:Organization
Organization Name:DRD MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:DYNOF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-207-8490
Mailing Address - Street 1:400 E 70TH ST
Mailing Address - Street 2:APT 1103
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5387
Mailing Address - Country:US
Mailing Address - Phone:917-207-8490
Mailing Address - Fax:212-737-0085
Practice Address - Street 1:271 MADISON AVE
Practice Address - Street 2:SUITE 1601
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1001
Practice Address - Country:US
Practice Address - Phone:212-682-2750
Practice Address - Fax:212-682-6588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225074-1208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWORKER COMPENSATIONOther225074-4W