=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013448455
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | OLGA MYSZKO M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2017
-----------------------------------------------------
Last Update Date | 07/25/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19 MURRAY ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10007-2240
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-500-6582
-----------------------------------------------------
Fax | 917-970-8372
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19 MURRAY ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10007-2240
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-500-6582
-----------------------------------------------------
Fax | 917-970-8372
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 305511
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2080A0000X
-----------------------------------------------------
Taxonomy Name | Pediatric Adolescent Medicine Physician
-----------------------------------------------------
License Number | 305511
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------