Healthcare Provider Details

I. General information

NPI: 1134491327
Provider Name (Legal Business Name): LYALYA OLGA STRUMKOVSKY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2012
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 NORTH WASHINGTON AVE
GREEN BROOK NJ
08812-0881
US

IV. Provider business mailing address

1007 ROBIN CT
GREEN BROOK NJ
08812-1737
US

V. Phone/Fax

Practice location:
  • Phone: 732-968-8900
  • Fax: 732-968-4609
Mailing address:
  • Phone: 908-720-4262
  • Fax: 732-369-3209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA09086600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: