Provider Demographics
NPI:1285646109
Name:YCMD PC
Entity type:Organization
Organization Name:YCMD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:VITALY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYKHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-375-2100
Mailing Address - Street 1:2790 W 5TH ST
Mailing Address - Street 2:APT. 4E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-4167
Mailing Address - Country:US
Mailing Address - Phone:646-623-3324
Mailing Address - Fax:800-349-4298
Practice Address - Street 1:1664 E 14TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1155
Practice Address - Country:US
Practice Address - Phone:718-375-2100
Practice Address - Fax:800-349-4298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEX491Medicare ID - Type Unspecified