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NPI Code Detail

MEDICARE: OLEG KOTELSKIY D.O., P.C.

MEDICARE: OLEG KOTELSKIY D.O., P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician2050591NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12050591OTHERNYLICENSE NUMBER

General Provider Information

NPI Number : 1508907510
Entity Type Code : Organization
Provider Name (Legal Business Name) : OLEG KOTELSKIY D.O., P.C.
Provider Business Mailing Address
First Line : 3816 NOSTRAND AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11235-2013
Country : US
Telephone Number : 347-713-6871
Fax Number : 347-713-6946
Provider Business Practice Location Address
First Line : 3816 NOSTRAND AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11235-2013
Country : US
Telephone Number : 347-713-6871
Fax Number : 347-713-6946
Authorized Official
Title or Position : PHYSICIAN
Name : OLEG KOTELSKIY
Credential : D.O.
Telephone Number : 347-713-6871
Provider Enumeration Date : 02/11/2007
Last Update Date : 08/22/2020

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