Healthcare Provider Details

I. General information

NPI: 1851609101
Provider Name (Legal Business Name): PLATINUM CARE MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2010
Last Update Date: 09/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 BAY PKWY UNIT 1E
BROOKLYN NY
11214-2663
US

IV. Provider business mailing address

81 LOTUS OVAL N
VALLEY STREAM NY
11581-2327
US

V. Phone/Fax

Practice location:
  • Phone: 516-507-8975
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: SERGEY ZHIVOTENKO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 516-507-8975