Provider Demographics
NPI:1225917735
Name:ROOTS ADDICTION & PSYCHIATRY MEDICAL GROUP, PC
Entity type:Organization
Organization Name:ROOTS ADDICTION & PSYCHIATRY MEDICAL GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/ CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREI
Authorized Official - Middle Name:
Authorized Official - Last Name:DOKUKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-647-5031
Mailing Address - Street 1:3939 ATLANTIC AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3535
Mailing Address - Country:US
Mailing Address - Phone:562-583-9345
Mailing Address - Fax:949-502-8887
Practice Address - Street 1:3939 ATLANTIC AVE STE 102
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3535
Practice Address - Country:US
Practice Address - Phone:562-583-9345
Practice Address - Fax:949-502-8887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-28
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health