Healthcare Provider Details

I. General information

NPI: 1982915773
Provider Name (Legal Business Name): OLEG STAROSELETSKY PHARM. D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 02/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 NEPTUNE AVE
BROOKLYN NY
11224-1675
US

IV. Provider business mailing address

12 PENCE RD
MANALAPAN NJ
07726-4307
US

V. Phone/Fax

Practice location:
  • Phone: 718-372-2700
  • Fax:
Mailing address:
  • Phone: 718-690-6825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number054561
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: