Individual provider Active NPI

Yevgeniy Mikityanskiy, D.O.

  • Gastroenterology Physician
  • Brooklyn, NY
National Provider Identifier
1538420823
Registry record updated Feb 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
279152 Issued in NY
Practice address
2601 Ocean Pkwy
Suite 4N98
Brooklyn, NY 11235-7745
Phone
(718) 616-3000
NPI assigned
Jun 3, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 26, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 279152 NY Primary

Addresses

Primary practice location

2601 Ocean Pkwy
Suite 4N98
Brooklyn, NY 11235-7745

Mailing address

2601 Ocean Pkwy
Suite 4N98
Brooklyn, NY 11235-7745
Phone (718) 864-5675

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20150710000280 NY Practitioner - Internal Medicine 4688986250 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
New York College of Osteo Medicine of New York Institute of Technology, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Triborough Gi PLLCGroup PAC ID 2466761531, 15 clinicians
Century Medical and Dental Center IncGroup PAC ID 8729070669, 107 clinicians

Practice addresses (Care Compare)

1672 Sheepshead Bay Rd
Brooklyn, NY 11235-3803
Phone (718) 332-0600

200 Livingston St
Brooklyn, NY 11201-5811
Phone (718) 522-3399

2043 Richmond Ave
Staten Island, NY 10314-3936
Phone (718) 332-0600

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy175
Upper gastrointestinal (GI) endoscopy for acid reflux83

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
279152NYMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Coney Island Medical Practice Plan, P.C. CurrentSince Mar 19, 2016 Accepting new patients
Century Medical & Dental Center Inc CurrentSince Aug 1, 2020 Accepting new patients
Triborough Gi PLLC Gastroenterology CurrentSince Jan 4, 2020 Accepting new patients
Triborough Gi PLLC CurrentSince Jan 4, 2020 Accepting new patients
Suny Downstate Medical Center Past Accepting new patients

Locations

1672 Sheepshead Bay Rd
#1674
Brooklyn, NY 11235

260 Avenue X
Brooklyn, NY 11223
Phone (718) 336-8855

200 Livingston St
Brooklyn, NY 11201
Phone (718) 522-3399

2601 Ocean Pkwy
Ste 4N98
Brooklyn, NY 11235
Phone (718) 616-3779

1517 Voorhies Ave
Brooklyn, NY 11235
Phone (718) 368-1666

1672 Sheepshead Bay Rd
Brooklyn, NY 11235
Phone (718) 795-2734

2601 Ocean Pkwy
Brooklyn, NY 11235
Phone (718) 616-5354

2043 Richmond Ave
Staten Island, NY 10314
Phone (718) 710-4906

Networks

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

Interoperability endpoints

  • Direct secure messaging: ymikityanskiy146400@nychhc.direct-ci.com

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1338681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582675200000",
    "number": "1538420823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2601 OCEAN PKWY",
            "address_2": "SUITE 4N98",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112357745",
            "telephone_number": "718-864-5675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 OCEAN PKWY",
            "address_2": "SUITE 4N98",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112357745",
            "telephone_number": "718-616-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIKITYANSKIY",
        "first_name": "YEVGENIY",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-06-03",
        "last_updated": "2020-02-26",
        "certification_date": "2020-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NY",
            "license": "279152",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.