1972535672 NPI number — DR. MIA DUKOFSKY D.C.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972535672 NPI number — DR. MIA DUKOFSKY D.C.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

DUKOFSKY

Provider First Name:

MIA

Provider Middle Name:

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

D.C.

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1972535672

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/24/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

520 NE 20TH ST APT 206

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

WILTON MANORS

Provider Business Mailing Address State Name:

FL

Provider Business Mailing Address Postal Code:

33305-2104

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

631-897-5246

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

6030 HOLLYWOOD BLVD STE 250

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

HOLLYWOOD

Provider Business Practice Location Address State Name:

FL

Provider Business Practice Location Address Postal Code:

33024-7972

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

954-908-6662

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

07/06/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 111N00000X , with the licence number:  X009134 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 111N00000X , with the licence number: CH13886 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 139518 . This is a "PRISM" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 5897920 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 113423471 . This is a "MAGNACARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 7633479 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: NY09134 . This is a "LANDMARK" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 2018267 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 103013 . This is a "HERITAGE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 010757455 . This is a "HORIZON HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: X5T371 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 2952860 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 470609 . This is a "PHCS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: C09134 . This is a "WORKERS COMP." identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".