NPIMap

Individual provider Active NPI

Dmitry Reznikoff, D.O.

  • Internal Medicine Physician
  • Rego Park, NY
National Provider Identifier
1902989502
Registry record updated Jan 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
231092 Issued in NY
Practice address
6433 99TH St
Medical Office Suite
Rego Park, NY 11374-3522
Phone
(718) 275-3587
Fax
(718) 275-3587
NPI assigned
Oct 24, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 17, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 231092 NY Primary
Internal Medicine Physician 207R00000X 34.009711 OH

Addresses

Primary practice location

6433 99TH St
Medical Office Suite
Rego Park, NY 11374-3522

Mailing address

6433 99TH St
Medical Office Suite
Rego Park, NY 11374-3522
Phone (718) 275-3587

Other identifiers 3

IdentifierTypeStateIssuer
02551522MedicaidNY
0054696MedicaidOH
3810024787MedicaidWV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, RI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040515000423 NY Practitioner - Internal Medicine 1355331984 Reassigns benefits to 2 organizations
Practice locations: Rego Park, NY
I20151215000886 RI Practitioner - Internal Medicine 1355331984 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Newburgh Physician Services PCGroup PAC ID 2264666767, 9 clinicians

Practice addresses (Care Compare)

1 Wingate Way
Highland, NY 12528-2143
Phone (845) 691-6800

115 Cass Ave
Woonsocket, RI 02895-4705
Phone (401) 769-4100

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
231092NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cogent Medical Care PC Internal Medicine CurrentSince Jun 24, 2017 Accepting new patients
Newburgh Physician Services PC CurrentSince Feb 3, 2020 Accepting new patients
Prime Healthcare Services Landmark LLC CurrentSince Oct 1, 2016 Accepting new patients
Hni Medical Services Internal Medicine CurrentSince Oct 11, 2015 Accepting new patients
Prime Healthcare Services Landmark LLC CurrentSince Oct 1, 2016 Accepting new patients
Nassau Gastroenterology Associates, P.C. Past Accepting new patients
Personal Touch Medical Care, P.C. PastSince Aug 13, 1996 Accepting new patients
East Shore Medical PC Internal Medicine Past Accepting new patients
St. Joseph'S Hospital, Yonkers Past Accepting new patients

Locations

75 Remittance Dr
Dept 1653
Chicago, IL 60675

66 W Gilbert St
Tinton Falls, NJ 07701
Phone (732) 212-0051

1 Wingate Way
Highland, NY 12528
Phone (845) 561-4400

70 Dubois St
Newburgh, NY 12550
Phone (845) 534-4673

160 N Midland Ave
Nyack, NY 10960
Phone (845) 348-2000

101 Hospital Rd
Patchogue, NY 11772
Phone (631) 654-7100

127 S Broadway
Yonkers, NY 10701
Phone (914) 378-7342

115 Cass Ave
Woonsocket, RI 02895
Phone (401) 356-1701

7500 Rialto Blvd
Ste 1-140
Austin, TX 78735

Organizations & group practices 9

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.

Hospital & facility affiliations 16

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1358380800000",
    "number": "1902989502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6433 99TH ST",
            "address_2": "MEDICAL OFFICE SUITE",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113743522",
            "telephone_number": "718-275-3587",
            "fax_number": "718-275-3587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6433 99TH ST",
            "address_2": "MEDICAL OFFICE SUITE",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113743522",
            "telephone_number": "718-275-3587",
            "fax_number": "718-275-3587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REZNIKOFF",
        "first_name": "DMITRY",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-24",
        "last_updated": "2013-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "231092",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "34.009711",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02551522",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0054696",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810024787",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rego Park, NY

Sources for this page

Verify at the official NPI Registry.