Provider Demographics
NPI:1174578165
Name:SHTRAMBRAND, DMITRY (MD)
Entity type:Individual
Prefix:DR
First Name:DMITRY
Middle Name:
Last Name:SHTRAMBRAND
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:PO BOX 843398
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-3398
Mailing Address - Country:US
Mailing Address - Phone:845-353-5600
Mailing Address - Fax:845-353-3474
Practice Address - Street 1:2 CROSFIELD AVE
Practice Address - Street 2:SUITE 318
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2226
Practice Address - Country:US
Practice Address - Phone:845-353-5600
Practice Address - Fax:845-353-3474
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07719100207R00000X
NY252395207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0048372Medicaid
1174578165OtherNPI
NJ084845VEAMedicare PIN