Provider Demographics
NPI:1538250782
Name:LITVINOV, SERGEY (DDS)
Entity type:Individual
Prefix:DR
First Name:SERGEY
Middle Name:
Last Name:LITVINOV
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 BRUCE ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-1803
Mailing Address - Country:US
Mailing Address - Phone:646-522-9752
Mailing Address - Fax:
Practice Address - Street 1:333 E 79TH ST
Practice Address - Street 2:SUITE 1U
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-0956
Practice Address - Country:US
Practice Address - Phone:212-744-5544
Practice Address - Fax:212-744-5556
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0441761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01346510Medicaid