Provider Demographics
NPI:1124152129
Name:DOCTOR ON WHEELS MEDICAL PC
Entity type:Organization
Organization Name:DOCTOR ON WHEELS MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YURY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMDBORG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-375-8052
Mailing Address - Street 1:2005 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-7335
Mailing Address - Country:US
Mailing Address - Phone:718-787-0279
Mailing Address - Fax:718-787-0270
Practice Address - Street 1:2005 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-7335
Practice Address - Country:US
Practice Address - Phone:718-787-0279
Practice Address - Fax:718-787-0270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW85861Medicare ID - Type Unspecified