Dimitri Fedorov, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

2148 Ocean Ave FL 5
Brooklyn, NY 11229-1484

Phone

(212) 398-1288

NPI assigned

Dec 1, 2025

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2026

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Vanguard DermatologyGroup PAC ID 2365475977, 10 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Vanguard Dermatology

  • Specialist
  • Brooklyn, NY
  • NPI 1619179009
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1764547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764547200000",
    "number": "1275495046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2148 OCEAN AVE FL 5",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112291484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2148 OCEAN AVE FL 5",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112291484",
            "telephone_number": "212-398-1288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FEDOROV",
        "first_name": "DIMITRI",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-12-01",
        "last_updated": "2025-12-01",
        "certification_date": "2025-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Valentina Fedonyuk, MS ED
• Liliia Fedora
• Elina Fedorenko, SC
• Olga Fedorenko
• Volodimir Fedoriv
• Peter Vladimir Fedorov, MD
• Danylo Fedotov
• Oksana Fedotova, M.S. CF-SLP TSSLD BE
• Hana Fedyukova, M.A.CCC-SLP
• Feel at Home Adult Day Care Center

• Medical Physician Assistant in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Medical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.