Provider Demographics
NPI:1669631479
Name:BERENZON, DMITRIY (MD)
Entity Type:Individual
Prefix:DR
First Name:DMITRIY
Middle Name:
Last Name:BERENZON
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 1:159 BARNEGAT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-5402
Mailing Address - Country:US
Mailing Address - Phone:845-454-1942
Mailing Address - Fax:845-452-4638
Practice Address - Street 1:159 BARNEGAT RD STE 101
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-5402
Practice Address - Country:US
Practice Address - Phone:845-454-1942
Practice Address - Fax:845-452-4638
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245284207RH0003X
NC2010-00928207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology