Dmitry Khasak MD PC Inc

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

DMITRY KHASAK MD PC INC

Practice address

100 Pavonia Ave Ste 409
Jersey City, NJ 07310-2778

Phone

(201) 626-4040

Fax

(866) 861-0767

NPI assigned

Jun 13, 2012

Last updated

Jun 13, 2012By 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

Mr. Eugene Gerlants

Title

Manager

Phone

(201) 889-7047

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jeffrey Tuazon, NP

  • Dermatology Physician
  • Jersey City, NJ
  • NPI 1518674621
  Medicare reassignment Care Compare group NPD
• Dmitry Khasak, MD

  • Dermatology Physician
  • New York, NY
  • NPI 1649258286

  NJ

  Medicare reassignment Care Compare group NPD
• Lyudmila Magakyan-Martinez, NP

  • Dermatology Physician
  • New York, NY
  • NPI 1255757134

  NJ

  Medicare reassignment Care Compare group NPD
• Santiago Alberto Centurion, M.D.

  • Dermatology Physician
  • Old Bridge, NJ
  • NPI 1710099585
  NPD (past)
• Dafna Rachel Wild, PA

  • Physician Assistant
  • Jersey City, NJ
  • NPI 1174750319
  NPD (past)
• Diana Elish, M.D.

  • Internal Medicine Physician
  • Rego Park, NY
  • NPI 1821284142
  NPD (past)

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

{
    "created_epoch": "1339545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339545600000",
    "number": "1679835946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 PAVONIA AVE STE 409",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073102778",
            "telephone_number": "201-626-4040",
            "fax_number": "866-861-0767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 PAVONIA AVE STE 409",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073102778",
            "telephone_number": "201-626-4040",
            "fax_number": "866-861-0767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DMITRY KHASAK MD PC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-13",
        "last_updated": "2012-06-13",
        "status": "A",
        "authorized_official_last_name": "GERLANTS",
        "authorized_official_first_name": "EUGENE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "201-889-7047",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Divinecare Physical Therapy LLC
• Lucy Elizabeth Dixon, RN, IBCLC
• Alita Logrono Dizon, M.D.
• Denver Dizon
• Melissa I Dizon, RPH, PHARMD
• Doctor's Medical Clinic PA
• Divya Dodhia, LCSW
• Tanvi Dodia, LAC
• Donna Doherty
• Allison Rose Dolan, DNP, APN-CRNA

• Dermatology Physician in Jersey City, NJ
• Providers in Jersey City, NJ by specialty
• Dermatology Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.