MEDICARE: SERGEY KALITENKO

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
1	207R00000X	Internal Medicine Physician	211326-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740295278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SERGEY KALITENKO

Provider Business Mailing Address
First Line	:	2952 BRIGHTON 3RD ST STE 201
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-7078
Country	:	US
Telephone Number	:
Fax Number	:	716-221-8626

Provider Business Practice Location Address
First Line	:	1701 QUENTIN RD STE 201
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1269
Country	:	US
Telephone Number	:	718-982-9200
Fax Number	:	716-221-8626

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	05/07/2026

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