Individual
MR. IGOR DMYTRIENKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
51 CHESTNUT ST, RIDGEWOOD, NJ 07450-3873
(201) 670-9215
Mailing address
51 CHESTNUT ST, RIDGEWOOD, NJ 07450-3873
(201) 670-9215
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
25MA06920100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8056803
—
NJ
Enumeration date
01/29/2007
Last updated
09/20/2007
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