Healthcare Provider Details

I. General information

NPI: 1871971051
Provider Name (Legal Business Name): OLGA KHEYSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2015
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3371 RICHMOND AVE LOWR LEFT
STATEN ISLAND NY
10312-2025
US

IV. Provider business mailing address

9 MALLOW ST
STATEN ISLAND NY
10309-1731
US

V. Phone/Fax

Practice location:
  • Phone: 929-203-9494
  • Fax: 347-983-6126
Mailing address:
  • Phone: 929-203-9494
  • Fax: 347-983-6126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number285998
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: