Individual
ALEXANDER DEMIDENKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2004 SEAGIRT BLVD, BASEMENT FLOOR, FAR ROCKAWAY, NY 11691-2802
(718) 868-8668
(718) 868-8611
Mailing address
2004 SEAGIRT BLVD BSMT FLOOR, FAR ROCKAWAY, NY 11691-2802
(810) 444-9183
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
249146
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03195782
—
NY
01
—
249146
LICENSE
NY
Enumeration date
05/29/2007
Last updated
03/20/2019
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