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General NPI Number Information
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NPI Number | 1861413981
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Entity Type | Organization
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Legal Business Name | PETRYCHENKO PHYSICIAN PC
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 12/26/2014
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Provider Practice Location Address
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Address Line | 2960 OCEAN AVE FL 6
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City | BROOKLYN
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State | NY
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Zip | 11235-3202
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Country | US
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Telephone | 718-336-5123
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Fax | 718-336-5137
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Provider Business Mailing Address
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Address Line | 2960 OCEAN AVE FL 6
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City | BROOKLYN
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State | NY
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Zip | 11235-3202
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Country | US
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Telephone | 718-336-5123
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Fax | 718-336-5137
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DMITRI PETRYCHENKO
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Credential | M.D.
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Telephone | 718-336-5123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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