# EUGENE DYAKOVETSKY MD. LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942460753
- **Authorized official:** EUGENE DYAKOVETSKY MD (PRESIDENT)
- **Authorized official phone:** (267) 471-0089

## Contact information

- **Practice address:** 201 LAKESIDE PARK, STE A, SOUTHAMPTON, PA 18966-4049
- **Practice address phone:** (215) 322-1058
- **Practice address fax:** (215) 322-1059
- **Mailing address:** 201 LAKESIDE PARK, STE A, SOUTHAMPTON, PA 18966-4049

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/16/2008
- **Last updated:** 06/16/2008