Healthcare Provider Details

I. General information

NPI: 1841486545
Provider Name (Legal Business Name): GENNADY UKRAINSKY MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108-12 72ND AVE 3RD FLOOR
FOREST HILLS NY
11375-7080
US

IV. Provider business mailing address

PO BOX 2625
NEW YORK NY
10009-8925
US

V. Phone/Fax

Practice location:
  • Phone: 718-544-9300
  • Fax: 718-544-9301
Mailing address:
  • Phone: 914-471-3422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: EMILY LAM
Title or Position: CREDENTIALING
Credential:
Phone: 914-471-3422