Provider Demographics
NPI:1669445615
Name:DMITRI ALDEN, MD,PC
Entity type:Organization
Organization Name:DMITRI ALDEN, MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DMITRI
Authorized Official - Middle Name:
Authorized Official - Last Name:ALDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-452-2120
Mailing Address - Street 1:110 MAIN ST
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-6707
Mailing Address - Country:US
Mailing Address - Phone:845-452-2120
Mailing Address - Fax:845-452-2104
Practice Address - Street 1:110 MAIN ST
Practice Address - Street 2:SUITE 2C
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-6707
Practice Address - Country:US
Practice Address - Phone:845-452-2120
Practice Address - Fax:845-452-2104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-09
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2298922086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherFEDERAL TAX ID NUMBER
NY=========OtherFEDERAL TAX ID NUMBER