Healthcare Provider Details

I. General information

NPI: 1497385959
Provider Name (Legal Business Name): ADAM A DMYTRIW MD MPH MSC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLARKSON AVE
BROOKLYN NY
11203-2012
US

IV. Provider business mailing address

450 CLARKSON AVE
BROOKLYN NY
11203-2012
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-2502
  • Fax: 718-270-1946
Mailing address:
  • Phone: 718-270-2502
  • Fax: 718-270-1946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number333351
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: