MEDICARE: DR. IGOR BENEDITSKIY MD, DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	237675	NY
2	207Q00000X	Family Medicine Physician	237675	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043396047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IGOR BENEDITSKIY MD, DO

Provider Business Mailing Address
First Line	:	3743 MERMAID AVE
Second Line	:	2ND FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11224-1234
Country	:	US
Telephone Number	:	718-576-1212
Fax Number	:	718-332-7110

Provider Business Practice Location Address
First Line	:	2646 E 14TH ST UNIT 1M
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3916
Country	:	US
Telephone Number	:	718-576-1212
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	08/03/2022

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