Healthcare Provider Details

I. General information

NPI: 1851211809
Provider Name (Legal Business Name): DMITRIA VESELAK
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 SUNRISE HWY STE 200
LYNBROOK NY
11563-2950
US

IV. Provider business mailing address

123 GROVE AVE STE 216
CEDARHURST NY
11516-2302
US

V. Phone/Fax

Practice location:
  • Phone: 516-350-8564
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number131887
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: