Provider Demographics
NPI:1245366152
Name:SHYKNEVSKY, IOSIF GREGORY (DDS)
Entity type:Individual
Prefix:DR
First Name:IOSIF
Middle Name:GREGORY
Last Name:SHYKNEVSKY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JOSEPH
Other - Middle Name:GREGORY
Other - Last Name:SHYKNEVSKY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2523 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3915
Mailing Address - Country:US
Mailing Address - Phone:718-934-0470
Mailing Address - Fax:718-339-0466
Practice Address - Street 1:2523 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3915
Practice Address - Country:US
Practice Address - Phone:718-934-0470
Practice Address - Fax:718-339-0466
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0471931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01804791Medicaid