Healthcare Provider Details

I. General information

NPI: 1174779359
Provider Name (Legal Business Name): OLENA GUZHVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 04/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 QUEENS ST STE 100
SYOSSET NY
11791-3058
US

IV. Provider business mailing address

PO BOX 426
SYOSSET NY
11791-0426
US

V. Phone/Fax

Practice location:
  • Phone: 516-277-8490
  • Fax:
Mailing address:
  • Phone: 516-864-0040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number251871
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD036791
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: