Yakov Dudelzak, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

243425 Issued in NY

Practice address

2615 E 16TH St
2ND Floor
Brooklyn, NY 11235-3805

Phone

(718) 263-0300

NPI assigned

Apr 3, 2007

Sex

Male

Sole proprietor

Yes

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

Dermatology

Education

Georgia College of Eclectric Medicine and Surgery, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Accredited Dermatology, Laser & Cosmetic Surgery, P.C.

  • Dermatology Physician
  • Brooklyn, NY
  • NPI 1285872275
  Medicare reassignment NPD Authorized official
• Boris Dudelzak DO PC

  • Family Medicine Physician
  • Brooklyn, NY
  • NPI 1477719128
  NPD (past)

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194393600000",
    "number": "1902928997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "567 DONALD LN",
            "city": "WOODMERE",
            "state": "NY",
            "postal_code": "115981516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2615 E 16TH ST",
            "address_2": "2ND FLOOR",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112353805",
            "telephone_number": "718-263-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUDELZAK",
        "first_name": "YAKOV",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-03",
        "last_updated": "2007-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NY",
            "license": "243425",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "560311",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02870744",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dunessa Anesha Pamela Ducrepin
• Maria Elena Duda, M.D.
• Madhavi Duddella
• Nagamma Duddempudi, M.D.
• Sam Duddempudi, MD
• Bhupendra Vrajlal Dudhia, M.D
• Barbara Lynn Dudley, CASAC
• Samara C Dudley
• Tamela Dudley, PT
• Oksana Dudnik

• Dermatology Physician in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Dermatology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2007; 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.