Eugene Dyakovetsky MD. LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

Legal business name

EUGENE DYAKOVETSKY MD. LLC

Practice address

201 Lakeside Park
Ste a
Southampton, PA 18966-4049

Phone

(215) 322-1058

Fax

(215) 322-1059

NPI assigned

Jun 16, 2008

Last updated

Jun 16, 2008By 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

Eugene Dyakovetsky, MD

Title

President

Phone

(267) 471-0089

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1213574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213574400000",
    "number": "1942460753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 LAKESIDE PARK",
            "address_2": "STE A",
            "city": "SOUTHAMPTON",
            "state": "PA",
            "postal_code": "189664049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 LAKESIDE PARK",
            "address_2": "STE A",
            "city": "SOUTHAMPTON",
            "state": "PA",
            "postal_code": "189664049",
            "telephone_number": "215-322-1058",
            "fax_number": "215-322-1059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EUGENE DYAKOVETSKY MD. LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-16",
        "last_updated": "2008-06-16",
        "status": "A",
        "authorized_official_last_name": "DYAKOVETSKY",
        "authorized_official_first_name": "EUGENE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "267-471-0089",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Medical Specialty Clinic/Center in Southampton, PA
• Providers in Southampton, PA by specialty
• Medical Specialty Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2008; 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.