Provider Demographics
NPI:1720085061
Name:KONSKY, DMITRY (DO)
Entity Type:Individual
Prefix:DR
First Name:DMITRY
Middle Name:
Last Name:KONSKY
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 1:31 SARAH DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-6321
Mailing Address - Country:US
Mailing Address - Phone:469-371-8466
Mailing Address - Fax:
Practice Address - Street 1:1 HEALTHY WAY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-1551
Practice Address - Country:US
Practice Address - Phone:516-632-3666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225308208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY138AA2OtherEMPIRE
NY02411503Medicaid
NY21234307347OtherBEECHSTREET
NY2361642OtherUNITED HEALTHCARE
NY281699BOtherMAGNACARE
NYKD5308OtherATLANTIS
NYP3612466OtherOXFORD
NY4C9819OtherHEALTHNET
NY9295519OtherPHCS
NY2100417OtherFIRSTHEALTH
NY2589947OtherGHI
NY4525743OtherCIGNA
NY202203POtherHIP
NY431975074Other1199 NATIONAL BENEFIT FUN
NY431975074OtherHORIZON
NY7826491OtherAETNA
NY7826491OtherAETNA
NY159AK1Medicare ID - Type Unspecified