Provider Demographics
NPI:1508366758
Name:DR. DADAMOVA MEDICAL PC
Entity Type:Organization
Organization Name:DR. DADAMOVA MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DADAMOVA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:646-920-8056
Mailing Address - Street 1:41 PAMELA LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-4438
Mailing Address - Country:US
Mailing Address - Phone:646-920-8056
Mailing Address - Fax:718-891-0635
Practice Address - Street 1:3071 BRIGHTON 13TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5607
Practice Address - Country:US
Practice Address - Phone:718-332-3676
Practice Address - Fax:718-891-0635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231534207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty