Alexander Demidenko, D.O.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

249146 Issued in NY

Practice address

2004 Seagirt Blvd
Basement Floor
Far Rockaway, NY 11691-2802

Phone

(718) 868-8668

Fax

(718) 868-8611

NPI assigned

May 29, 2007

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

Other identifiers 2

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Ophthalmology

Education

New York College of Osteo Medicine of New York Institute of Technology, 2003

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

Networks

• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H9678

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.

• Long Island Ophthalmology & Eye Surgery, P. C.

  • Ophthalmology Physician
  • Far Rockaway, NY
  • NPI 1255646212
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1180396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553040000000",
    "number": "1356542591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2004 SEAGIRT BLVD BSMT FLOOR",
            "city": "FAR ROCKAWAY",
            "state": "NY",
            "postal_code": "116912802",
            "telephone_number": "810-444-9183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2004 SEAGIRT BLVD",
            "address_2": "BASEMENT FLOOR",
            "city": "FAR ROCKAWAY",
            "state": "NY",
            "postal_code": "116912802",
            "telephone_number": "718-868-8668",
            "fax_number": "718-868-8611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMIDENKO",
        "first_name": "ALEXANDER",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-29",
        "last_updated": "2019-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NY",
            "license": "249146",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03195782",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "249146",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Veronica Delarosa, NP
• Marianne Millano Delcastillo, DPT
• Chinnel Deleon, LPN
• David Jonathan Dembitzer, P.T
• Sarah Dembitzer, TEACHER
• Sandra Denis, LPN
• Latoya Khalilah Dennis, RN
• Dental Sleep Medicine Center for Snoring and Sleep Apnea LLC
• Gunjan Desai, MD
• Sasha Deshong, RN

• Ophthalmology Physician in Far Rockaway, NY
• Providers in Far Rockaway, NY by specialty
• Ophthalmology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2019; 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.