Doctor Name: | DMITRY V SHMERKOVICH |
NPI Number: | 1043486285 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DO |
License Number: | 258729 |
Business Practice Address: | 2711 Avenue X Apt 3e Brooklyn, NY - 112352028 |
Business Phone Number: | 6466418292 |
Business Fax Number: | 8476562324 |
Mailing Address: | 2711 Avenue X Apt 3e, Medical Staff Office T14 BROOKLYN |
State: | NY |
Postal Code: | 112352028 |
Phone Number: | 6466418292 |
Fax Number: | 8476562324 |
NPI Enumeration Date: | 05/07/2008 |
NPI Last Update Date: | 11/06/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 258729 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |