Provider Demographics
NPI:1811192248
Name:DIAGNOSTIC NEUROLOGY PC
Entity Type:Organization
Organization Name:DIAGNOSTIC NEUROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHIVOTENKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-791-0761
Mailing Address - Street 1:81 LOTUS OVAL N
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-2327
Mailing Address - Country:US
Mailing Address - Phone:516-791-0761
Mailing Address - Fax:
Practice Address - Street 1:2797 OCEAN PKWY
Practice Address - Street 2:2 FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7868
Practice Address - Country:US
Practice Address - Phone:718-576-1212
Practice Address - Fax:718-332-7110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02677663Medicaid
NY02677663Medicaid
NY02677663Medicaid
NY07305Medicare ID - Type UnspecifiedGHI
NY630N51Medicare ID - Type Unspecified