Igor Dmytrienko, MD

Primary specialty

SpecialistTaxonomy code 174400000X

License

25MA06920100 Issued in NJ

Practice address

51 Chestnut St
Ridgewood, NJ 07450-3873

Phone

(201) 670-9215

NPI assigned

Jan 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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190246400000",
    "number": "1881730026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "51 CHESTNUT ST",
            "city": "RIDGEWOOD",
            "state": "NJ",
            "postal_code": "074503873",
            "telephone_number": "201-670-9215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 CHESTNUT ST",
            "city": "RIDGEWOOD",
            "state": "NJ",
            "postal_code": "074503873",
            "telephone_number": "201-670-9215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DMYTRIENKO",
        "first_name": "IGOR",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-29",
        "last_updated": "2007-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NJ",
            "license": "25MA06920100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8056803",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Thomas Lee Dimitry, PH.D.
• Joseph John Diorio Jr., M.D.
• Marisa Distefano, LPC
• Ruthellen Grace Dixon, OTR
• Ismar Dizdarevic, M.D.
• Keith F Dockery, M.D.
• Kristin Doherty, LPC
• Melissa L. Donahue
• Susan Joan Donnelly, LCSW
• Margaret T Doty, LSW

• Specialist in Ridgewood, NJ
• Providers in Ridgewood, NJ by specialty
• Specialist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2007; 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.