Healthcare Provider Details

I. General information

NPI: 1033565221
Provider Name (Legal Business Name): DR.DENNIS MEDICAL P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2016
Last Update Date: 05/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 MOTT ST SUITE 401
NEW YORK NY
10013-5540
US

IV. Provider business mailing address

128 MOTT ST SUITE 401
NEW YORK NY
10013-5540
US

V. Phone/Fax

Practice location:
  • Phone: 212-219-2723
  • Fax: 718-795-4395
Mailing address:
  • Phone: 212-219-2723
  • Fax: 718-795-4395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number253332
License Number StateNY

VIII. Authorized Official

Name: DR. DENNIS RADOSHKEVICH
Title or Position: PRESIDENT
Credential: MD
Phone: 347-254-0826