Provider Demographics
NPI:1760431761
Name:ELKIN, DMITRIY (MD)
Entity Type:Individual
Prefix:DR
First Name:DMITRIY
Middle Name:
Last Name:ELKIN
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 1:1831 BAYRIDGE AVENUR
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204
Mailing Address - Country:US
Mailing Address - Phone:718-347-3120
Mailing Address - Fax:718-337-1548
Practice Address - Street 1:407 BEACH 20TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-3647
Practice Address - Country:US
Practice Address - Phone:718-471-7010
Practice Address - Fax:718-337-1548
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2214181207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02171617Medicaid
NY02171617Medicaid
NY09388NMedicare ID - Type Unspecified