Individual
DMITRIY V KOLESNIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9530 QUEENS BLVD, REGO PARK, NY 11374-1136
(718) 275-7860
(718) 275-7882
Mailing address
9530 QUEENS BLVD, REGO PARK, NY 11374-1136
(718) 275-7860
(718) 275-7882
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
214729
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0078AJ
MEDICARE PTAN
NY
01
—
01S641
EMPIRE MEDICARE
NY
05
—
02196023
—
NY
01
—
0271GU
MEDICARE PTAN
NY
Enumeration date
07/12/2006
Last updated
04/29/2013
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