Provider Demographics
NPI:1669466249
Name:KADYMOFF, ELDAR (DO)
Entity Type:Individual
Prefix:DR
First Name:ELDAR
Middle Name:
Last Name:KADYMOFF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 SHEEPSHEAD BAY RD
Mailing Address - Street 2:NGM/PRIME CARE ON THE BAY
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3651
Mailing Address - Country:US
Mailing Address - Phone:718-332-8002
Mailing Address - Fax:718-332-8006
Practice Address - Street 1:1711 SHEEPSHEAD BAY RD
Practice Address - Street 2:NGM/PRIME CARE ON THE BAY
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3651
Practice Address - Country:US
Practice Address - Phone:718-332-8002
Practice Address - Fax:718-332-8006
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228086207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02391642Medicaid
NY895821Medicare ID - Type Unspecified
NY02391642Medicaid