Healthcare Provider Details

I. General information

NPI: 1740295278
Provider Name (Legal Business Name): SERGEY KALITENKO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 QUENTIN RD STE 201
BROOKLYN NY
11229-1269
US

IV. Provider business mailing address

2952 BRIGHTON 3RD ST STE 201
BROOKLYN NY
11235-7078
US

V. Phone/Fax

Practice location:
  • Phone: 718-982-9200
  • Fax: 716-221-8626
Mailing address:
  • Phone:
  • Fax: 716-221-8626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number211326-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: