Healthcare Provider Details

I. General information

NPI: 1174887418
Provider Name (Legal Business Name): OLENA MOKRYTSKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 07/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060 ELBERTSON ST APT 2O
ELMHURST NY
11373-2142
US

IV. Provider business mailing address

4060 ELBERTSON ST APT 2O
ELMHURST NY
11373-2142
US

V. Phone/Fax

Practice location:
  • Phone: 917-940-2450
  • Fax:
Mailing address:
  • Phone: 917-940-2450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0078001
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: