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General NPI Number Information
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NPI Number | 1003138926
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Entity Type | Organization
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Legal Business Name | AVENUE P MEDICAL SERVICES, PC
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Dates
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Enumeration Date | 02/19/2010
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Last Update Date | 07/21/2011
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Provider Practice Location Address
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Address Line | 214 AVENUE P
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City | BROOKLYN
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State | NY
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Zip | 11204-6573
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Country | US
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Telephone | 212-845-9255
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Fax | 347-602-4674
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Provider Business Mailing Address
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Address Line | 214 AVENUE P
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City | BROOKLYN
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State | NY
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Zip | 11204-6573
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Country | US
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Telephone | 212-845-9255
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Fax | 347-602-4674
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Authorized Official
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Title or Position | OWNER
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Name | DR. OLEG GUTNIK
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Credential | MD
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Telephone | 212-845-9255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 163630
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License Number State | NY
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