Individual
MR. DMITRY VINNIKOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPA-C
Contact information
Practice address
506 6TH ST, BROOKLYN, NY 11215-3609
(718) 780-3000
Mailing address
11701 PARK LN S APT D2G, RICHMOND HILL, NY 11418-1052
(917) 885-5960
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
013664
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G400009079
MEDICARE PROVIDER #
NY
Enumeration date
11/02/2009
Last updated
10/04/2013
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