| Diagnostic Neurology Pc | |
|
2797 Ocean Pkwy 2 Floor Brooklyn NY 11235-7868 | |
| (718) 576-1212 | |
| (718) 332-7110 |
| Full Name | Diagnostic Neurology Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2797 Ocean Pkwy, Brooklyn, New York |
| Authorized Official Name and Position | Sergey Zhivotenko (PRESIDENT) |
| Authorized Official Contact | 5167910761 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Diagnostic Neurology Pc 81 Lotus Oval N Valley Stream NY 11581-2327 Ph: (516) 791-0761 | Diagnostic Neurology Pc 2797 Ocean Pkwy 2 Floor Brooklyn NY 11235-7868 Ph: (718) 576-1212 |
| NPI Number | 1811192248 |
|---|---|
| Provider Enumeration Date | 06/16/2007 |
| Last Update Date | 03/07/2023 |
| Medicare PECOS PAC ID | 3577698158 |
|---|---|
| Medicare Enrollment ID | O20100414000662 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811192248 | NPI | - | NPPES |
| 02677663 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Secondary |
| 2084N0600X | Psychiatry & Neurology - Clinical Neurophysiology | (* (Not Available)) | Primary |
| Provider Name | Sergey Zhivotenko |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1154348092 PECOS PAC ID: 1658305511 Enrollment ID: I20050921000333 |
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