Provider Demographics
NPI:1245239664
Name:DITTMAR, KLAUS (MD)
Entity Type:Individual
Prefix:DR
First Name:KLAUS
Middle Name:
Last Name:DITTMAR
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 1:1999 MARCUS AVE STE 306
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1028
Mailing Address - Country:US
Mailing Address - Phone:516-627-1221
Mailing Address - Fax:516-627-6857
Practice Address - Street 1:1999 MARCUS AVE STE 306
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1028
Practice Address - Country:US
Practice Address - Phone:516-627-1221
Practice Address - Fax:516-627-6857
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY089981207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG400000974Medicare PIN
NY3790332441Medicare PIN
NYD14065Medicare UPIN
112711113Medicare PIN