Healthcare Provider Details

I. General information

NPI: 1376718395
Provider Name (Legal Business Name): DMITRIY Y TOKAR PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 55TH ST
BROOKLYN NY
11220-2508
US

IV. Provider business mailing address

1811 OCEAN PKWY APT 1I
BROOKLYN NY
11223-3059
US

V. Phone/Fax

Practice location:
  • Phone: 718-630-7000
  • Fax:
Mailing address:
  • Phone: 718-336-8396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberP63567
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: