Provider Demographics
NPI:1669407185
Name:NYC MEDICAL AND NEURODIAGNOSTIC PC
Entity type:Organization
Organization Name:NYC MEDICAL AND NEURODIAGNOSTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DMITRIY
Authorized Official - Middle Name:V
Authorized Official - Last Name:KOLESNIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-275-7860
Mailing Address - Street 1:6318 AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2923
Mailing Address - Country:US
Mailing Address - Phone:718-275-7860
Mailing Address - Fax:718-275-7882
Practice Address - Street 1:6318 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2923
Practice Address - Country:US
Practice Address - Phone:718-275-7860
Practice Address - Fax:718-275-7882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05722Medicare ID - Type Unspecified