Sea Gate Medical

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

License

205927 Issued in NY

Legal business name

SEA GATE MEDICAL

Practice address

1961 Coney Island Ave
Brooklyn, NY 11223-2328

Phone

(718) 344-7637

Fax

(718) 490-1468

NPI assigned

Jul 7, 2011

Last updated

Jul 7, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Valentin Pridatko, DO

Title

DO

Phone

(718) 236-5077

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1309996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309996800000",
    "number": "1316234669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2580 OCEAN PKWY",
            "address_2": "APT. 2L",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112357746",
            "telephone_number": "718-236-5077",
            "fax_number": "718-715-1437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1961 CONEY ISLAND AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112232328",
            "telephone_number": "718-344-7637",
            "fax_number": "718-490-1468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEA GATE MEDICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-07",
        "last_updated": "2011-07-07",
        "status": "A",
        "authorized_official_last_name": "PRIDATKO",
        "authorized_official_first_name": "VALENTIN",
        "authorized_official_title_or_position": "DO",
        "authorized_official_telephone_number": "718-236-5077",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "NY",
            "license": "205927",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "018288888537",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sea Breeze Pharmacy & Medical Supply Inc.
• Sea Breeze Podiatry Associates
• Sea Crest Acquisition I LLC (Sea Crest Nursing and Rehabilitation Center)
• Sea Crest Acquisition II, LLC (Cassena Kidney Care at Sea Crest)
• Sea Crest Health Care Center
• Seabreeze Endoscopy Inc
• Seabreeze Medical, PC
• Stephanie Sylvia Seabrooks, LPN
• Aisha Tanya Seaforth
• Oseia Seaforth

• Adult Medicine Physician in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Adult Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.