Provider Demographics
NPI:1902976509
Name:PODRUG, DINKO (MD)
Entity type:Individual
Prefix:MR
First Name:DINKO
Middle Name:
Last Name:PODRUG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 EAST END AVE
Mailing Address - Street 2:17C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-7954
Mailing Address - Country:US
Mailing Address - Phone:212-734-3307
Mailing Address - Fax:
Practice Address - Street 1:52 EAST END AVE
Practice Address - Street 2:17C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-7954
Practice Address - Country:US
Practice Address - Phone:212-734-3307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1430752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00589717Medicaid
NY0082896OtherGHI
B15153Medicare UPIN
NY0082896OtherGHI