Provider Demographics
NPI:1295728731
Name:ZHUKOVSKI, DMITRY (DO)
Entity type:Individual
Prefix:DR
First Name:DMITRY
Middle Name:
Last Name:ZHUKOVSKI
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 1:4766B BEDFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2606
Mailing Address - Country:US
Mailing Address - Phone:718-676-0404
Mailing Address - Fax:347-462-1280
Practice Address - Street 1:1920 E HALLANDALE BEACH BLVD STE 901
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4726
Practice Address - Country:US
Practice Address - Phone:786-733-1066
Practice Address - Fax:786-839-3258
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2023-01-11
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-14
Provider Licenses
StateLicense IDTaxonomies
NY232986207Q00000X
FLOS18656207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02385046Medicaid
FL113967000Medicaid
NY69V901Medicare ID - Type Unspecified