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General NPI Number Information
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NPI Number | 1184749723
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Entity Type | Individual
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Provider Name | OLEG BAZYLKO LAC
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Gender | Male
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 27W COLUMBIA STREET
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City | HEMPSTEAD
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State | NY
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Zip | 11550
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Country | US
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Telephone | 516-489-4666
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Fax |
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Provider Business Mailing Address
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Address Line | 1580 EAST 18TH STREET APT 5E
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City | BROOKLYN
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State | NY
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Zip | 11230
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Country | US
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Telephone | 917-279-6405
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 001778
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License Number State | NY
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