Provider Demographics
NPI:1548298870
Name:DITKOFF, EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:DITKOFF
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 1:1625 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3637
Mailing Address - Country:US
Mailing Address - Phone:516-369-8700
Mailing Address - Fax:516-289-8461
Practice Address - Street 1:1625 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-3637
Practice Address - Country:US
Practice Address - Phone:516-369-8700
Practice Address - Fax:516-289-8461
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167999174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNP389OtherOXFORD
NY6395250017OtherCIGNA PPO
NY45G401OtherBLUE SHIELD
NYN31807OtherPHS
NY4415353OtherAETNA PPO
NY1030013OtherAETNA HMO
NY6395250003OtherCIGNA HMO
NY7199999OtherGHI
NY6395250003OtherCIGNA HMO