Provider Demographics
NPI:1578794434
Name:DOCTOR ON CALL MEDICAL PC
Entity Type:Organization
Organization Name:DOCTOR ON CALL MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:DASHEVSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DO
Authorized Official - Phone:718-646-3333
Mailing Address - Street 1:2646 E 14TH ST
Mailing Address - Street 2:1ST.FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3916
Mailing Address - Country:US
Mailing Address - Phone:718-646-3333
Mailing Address - Fax:718-787-0270
Practice Address - Street 1:2646 E 14TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3916
Practice Address - Country:US
Practice Address - Phone:718-646-3333
Practice Address - Fax:718-787-0270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-27
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1578794434Medicaid
NYA100058505Medicare UPIN
NYG100058305Medicare UPIN