Healthcare Provider Details

I. General information

NPI: 1295728731
Provider Name (Legal Business Name): DMITRY ZHUKOVSKI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date: 03/24/2006
Reactivation Date: 04/14/2006

III. Provider practice location address

2500 E HALLANDALE BEACH BLVD STE 505
HALLANDALE BEACH FL
33009-4838
US

IV. Provider business mailing address

4766B BEDFORD AVE
BROOKLYN NY
11235-2606
US

V. Phone/Fax

Practice location:
  • Phone: 786-733-1066
  • Fax: 786-839-3258
Mailing address:
  • Phone: 718-676-0404
  • Fax: 347-462-1280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS18656
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number232986
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: