Provider Demographics
NPI:1275865966
Name:DMITRY DONSKY PHYSICIAN, PC
Entity Type:Organization
Organization Name:DMITRY DONSKY PHYSICIAN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DMITRY
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:DONSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-238-5729
Mailing Address - Street 1:453 77TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3205
Mailing Address - Country:US
Mailing Address - Phone:718-523-8572
Mailing Address - Fax:718-238-2047
Practice Address - Street 1:453 77TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3205
Practice Address - Country:US
Practice Address - Phone:718-523-8572
Practice Address - Fax:718-238-2047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220763207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02155755Medicaid
NYH40986Medicare UPIN