Healthcare Provider Details

I. General information

NPI: 1346689262
Provider Name (Legal Business Name): OLGA SYRITSYNA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 10/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 N BELLE MEAD RD
EAST SETAUKET NY
11733-3495
US

IV. Provider business mailing address

PO BOX 1559
STONY BROOK NY
11790-0989
US

V. Phone/Fax

Practice location:
  • Phone: 617-499-5160
  • Fax:
Mailing address:
  • Phone: 631-444-2599
  • Fax:

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 Code2084N0400X
TaxonomyNeurology Physician
License Number291340
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: