DMITRY V SAMSONOV (NPI# 1356595862) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356595862 |
| Entity Type | Individual |
| Full Name | DMITRY V SAMSONOV |
| Credential | MD |
| Practice Address |
19 Bradhurst Ave Ste 1400 Hawthorne NY 10532-2140 |
| Mailing Address |
Po Box 1020 Hawthorne NY 10532-7507 |
| Practice Telephone | 9144937583 |
| Practice Fax Number | 9145944011 |
| Mailing Telephone | 9144937583 |
| Mailing Fax Number | 9145944011 |
| Enumeration Date | 2008-11-11 |
| Last Update Date | 2013-07-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0210X |
Pediatrics Specialization: Pediatric Nephrology |
269800 | NY | Allopathic & Osteopathic Physicians |
| N | 2080P0210X |
Pediatrics Specialization: Pediatric Nephrology |
003556 | NY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 03266039 | 05 |
| Street Address |
19 BRADHURST AVE STE 1400 |
| City | HAWTHORNE |
| State | NY |
| Zip Code | 10532-2140 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437152618 | Martin Cohen | Internal Medicine | 19 Bradhurst Ave, Ste 3850s, Hawthorne, NY 10532-2140 | 2005-05-23 |
| 1194368472 | Susan Eleanora Russo | Dietitian, Registered | 19 Bradhurst Ave, Hawthorne, NY 10532-2140 | 2019-10-19 |
| 1326536434 | Amanda Elizabeth Muldoon | Audiologist | 19 Bradhurst Ave, Hawthorne, NY 10532-2140 | 2018-04-24 |
| 1992252662 | Daniela Levin | Physician Assistant | 19 Bradhurst Ave, Ste 3050n, Hawthorne, NY 10532-2140 | 2016-09-09 |
| 1831564616 | Diane Lindsay-adler | Dietitian, Registered | 19 Bradhurst Ave, Hawthorne, NY 10532-2140 | 2015-12-05 |
| 1730551755 | Alessandra Marino | Physician Assistant | 19 Bradhurst Ave, Suite 2575, Hawthorne, NY 10532-2140 | 2015-10-29 |
| 1093190043 | Adedoyin Solomon | Nurse Practitioner | 19 Bradhurst Ave, Suite 2300, Hawthorne, NY 10532-2140 | 2015-07-20 |
| 1912396219 | Jaclyn Basso | Nurse Practitioner | 19 Bradhurst Ave, Suite 1400, Hawthorne, NY 10532-2140 | 2015-01-10 |
| 1073919874 | Jessica Hoffman | Audiologist | 19 Bradhurst Ave, Ste 3600s, Hawthorne, NY 10532-2140 | 2014-11-06 |
| 1841693413 | Amy Sue Habeck | Dietitian, Registered | 19 Bradhurst Ave, Suite 1700, Hawthorne, NY 10532-2140 | 2014-09-26 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447792924 | Avril Dunbar | Registered Nurse | 228-500 Linda Ave, Hawthorne, NY 10532 | 2016-11-15 |
| 1134572704 | Ronald Tomlinson Jr. | Licensed Practical Nurse | 228- 500 Linda Avenue, Hawthorne, NY 10532 | 2016-07-19 |
| 1831566843 | Noble A Thomas | Chiropractor | 153 Broadway Ste 1, Hawthorne, NY 10532 | 2015-08-25 |
| 1790169068 | Sheila Astorino | Case Manager/Care Coordinator | 281 Pythian Avenue, Hawthorne, NY 10532 | 2015-07-16 |
| 1962801381 | Edison Pena | Student in an Organized Health Care Education/Training Program | 2226 Linda Avenue, Hawthorne, NY 10532 | 2014-08-21 |
| 1093029720 | Kathleen B Shaps | Registered Nurse | 226 Linda Avenue, Hawthorne, NY 10532 | 2010-08-05 |
| 1457580839 | Tracey Leah Shannon | Nurse Practitioner | 19 Bradhurst Ave Ste 3850s, Hawthorne, NY 10532 | 2009-07-07 |
| 1033364930 | Aldo Joseph Porco Md | Psychiatry & Neurology | 500 Linda Ave., Hawthorne, NY 10532 | 2008-11-20 |
| 1164675443 | Joanne Mary Bortone | Occupational Therapist | 1 Skyline Drive Suite 298, Kidabilities, Hawthorne, NY 10532 | 2008-10-30 |
| 1306094420 | Jeffrey Scott Anderson | Counselor | 226 Linda Ave., Hawthorne, NY 10532 | 2008-09-03 |
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| Taxonomy Code | 2080P0210X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Nephrology |
| A pediatrician who deals with the normal and abnormal development and maturation of the kidney and urinary tract, the mechanisms by which the kidney can be damaged, the evaluation and treatment of renal diseases, fluid and electrolyte abnormalities, hypertension and renal replacement therapy. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) was provided by the American Osteopathic Board of Pediatrics. The Certification is no longer offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316949100 | Anna Zolotnitskaya | Pediatrics | 22 Saw Mill River Rd, Hawthorne, NY 10532-1533 | 2005-08-11 |
| 1710138185 | Robyn Matloff | Pediatrics | 19 Skyline Dr, Hawthorne, NY 10532-2134 | 2008-10-03 |
| 1417949702 | Robert A Weiss | Pediatrics | 19 Bradhurst Ave, Ste. 1400, Hawthorne, NY 10532-2140 | 2005-08-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396996211 | Adrian Spitzer | Pediatrics | 3326 Bainbridge Ave, Bronx, NY 10467-2800 | 2008-10-09 |
| 1013177286 | Natalie Somera Uy | Pediatrics | 3959 Broadway # Chn1115, New York, NY 10032-1559 | 2008-06-11 |
| 1992963417 | Pamela Singer | Pediatrics | 420 Lakeville Rd, New Hyde Park, NY 11042-1121 | 2008-05-30 |
| 1215071261 | Erin R Rademacher | Pediatrics | Box 777, 601 Elmwood Avenue, Rochester, NY 14642 | 2007-02-15 |
| 1942360011 | Howard Trachtman | Pediatrics | 227 E 30th St, New York, NY 10016-8203 | 2006-12-11 |
| 1780756361 | Consolacion Tanedo Pimentel | Pediatrics | 430 Strawtown Rd, West Nyack, NY 10994-1236 | 2006-11-15 |
| 1699851535 | Frederick J Kaskel | Pediatrics | 1251 Raleigh Rd, Mamaroneck, NY 10543-1232 | 2006-10-31 |
| 1396842522 | New York Specialty Physicians, LLP | Pediatrics | 125 Plandome Rd, Manhasset, NY 11030-2331 | 2006-09-20 |
| 1629087267 | Mount Sinai School of Medicine | Pediatrics | 5 East 98th. Street 12th. Floor, New York, NY 10029-6574 | 2006-08-05 |
| 1710925276 | Ayesa N Mian | Pediatrics | 601 Elmwood Ave Box 777, Rochester, NY 14642-0001 | 2006-06-04 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.