Active NPI
Dmitry Demydyuk, COTA
- Occupational Therapy Assistant
- Brooklyn, NY
National Provider Identifier
1861969925
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 008865-1
- Practice address
- 1772 46TH St Apt 2K
Brooklyn, NY 11204-6601 - Phone
- (718) 775-8707
- NPI assigned
- Oct 26, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 008865-1 | NY | Primary |
Addresses
Primary practice location
1772 46TH St Apt 2K
Brooklyn, NY 11204-6601
Mailing address
1772 46TH St Apt 2K
Brooklyn, NY 11204-6601
Phone (718) 775-8707
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 008865-1 | NY | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1540512000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1540512000000",
"number": "1861969925",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1772 46TH ST APT 2K",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112046601",
"telephone_number": "718-775-8707"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1772 46TH ST APT 2K",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112046601",
"telephone_number": "718-775-8707"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEMYDYUK",
"first_name": "DMITRY",
"credential": "COTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-10-26",
"last_updated": "2018-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "NY",
"license": "008865-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.