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Organization

AFFINITY MEDICAL PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. ILYA DOMNICH MD (OWNER)
(718) 758-4100
Entity
Organization

Contact information

Practice address
8635 21ST AVE, 1A, BROOKLYN, NY 11214-4049
(718) 758-4100
Mailing address
8635 21ST AVE, 1A, BROOKLYN, NY 11214-4049
(718) 758-4100

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
217873
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
217873
LISCENCE
NY
Enumeration date
02/24/2012
Last updated
02/24/2012
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