Physician Compare National (NPI:1336431907)

HEALTHCARE PROVIDER: VITALIY ZHIVOTENKO D.O.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1336431907
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9032350251
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20160902001047
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ZHIVOTENKO
	Individual professional last name
Provider First Name	VITALIY
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	NEW YORK COLLEGE OF OSTEO MEDICINE OF NEW YORK INSTITUTE OF TECHNOLOGY
	Individual professional's medical school
Graduation Year	2011
	Individual professional's medical school graduation year
Primary Specialty	PAIN MANAGEMENT
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	NEUROLOGY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	NEUROLOGY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	LR MEDICAL PLLC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	1052534666
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	5
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	2277 -83 CONEY ISLAND AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	2A
	Group Practice or individual's line 2 address
City	BROOKLYN
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	112233337
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7189989890
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y