MEDICARE: NEW YORK COMPREHENSIVE NEUROLOGY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	258729	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	258729	OTHER	NY	LISCENCE

General Provider Information

NPI Number	:	1487087201
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW YORK COMPREHENSIVE NEUROLOGY PC

Provider Business Mailing Address
First Line	:	2711 AVENUE X APT 3E
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-2028
Country	:	US
Telephone Number	:	646-641-8292
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 GREENE AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11238-6406
Country	:	US
Telephone Number	:	646-641-8292
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DMITRY SHMERKOVICH
Credential	:	DO
Telephone Number	:	646-641-8292

Provider Enumeration Date	:	08/15/2013
Last Update Date	:	03/20/2015

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